Mischer NeuroscieNce iNstitute report 2011

When physicians and patients choose

the Mischer Neuroscience Institute located at Memorial Hermann-Texas Medical Center, part of the 11-hospital Memorial Hermann Healthcare System, they’re choosing the largest and most comprehensive neuroscience program in Texas. The renowned faculty at the Mischer Neuroscience Institute works together in a coordinated attack against neurological disease. Thanks to their knowledge and talent, the Mischer Neuroscience Institute is nationally recognized for leading-edge medicine and consistently ranked among quality benchmarking organizations as a leader in clinical quality and patient safety.

Table of Contents

02 About Our Institute10 2011 Accolades18 Scope of Services

— Brain Tumor — Cerebrovascular — Epilepsy — Memory Disorders — Movement Disorders — Multiple Sclerosis — Neuromuscular Disorders — Neurorehabilitation — Neurotrauma/Critical Care — Spine

48 Research & Innovation66 Selected Publications78 Patient Stories94 Staff Listing

We are pleased to share with you the Mischer Neuroscience Institute (MNI) Clinical Achievements Report

for fiscal year 2011, which highlights our clinical expertise and accomplishments in quality, safety,

clinical care and research from July 2010 through June 2011. The report is a publication of MNI, part of

the 11-hospital Memorial Hermann system, in collaboration with The University of Texas Health Science

Center at Houston (UTHealth) Medical School. We hope you find the information on the pages that follow

interesting, informative and valuable.

We had much to celebrate over the last year. Our quality outcomes and long history of innovation in

the field of neuroscience continue to ensure that we attract accomplished physician faculty members

who share our commitment to raising the bar with first-rate clinical programs, continued growth and

breakthrough research applied daily in the operating room and at the bedside. In 2010, we welcomed

eight talented faculty members to MNI: neurosurgeon Arthur L. Day, M.D.; neurologist and neuro-

oncologist Jay-Jiguang Zhu, M.D., Ph.D.; neuropsychiatrist and behavioral neurologist Paul Schulz, M.D.;

vascular neurologist Vivek Misra, M.D.; neurologists Anita Madan, M.D., and Holly Varner, M.D.; and

researchers Min Li, Ph.D., and Ying Xia, M.D., Ph.D.

We also expanded our capability to treat neurological disease through the addition of new technology,

including the most technologically advanced Gamma Knife model available – the new Leksell Gamma

Knife® Perfexion™. We acquired a Siemens Artis™ zee biplane system in our vascular interventional suite,

which allows for improved visualization and greater precision in the treatment of some of the most complex

brain and spine vascular diseases. A new Varian Trilogy linear accelerator for stereotactic radiosurgery

will allow noninvasive treatment of benign and malignant tumors, and the addition of a Magnes 3600

WH MEG brain imaging system will allow us to expand the technology’s use in diagnosing epilepsy,

aneurysms, cortical brain lesions, arteriovenous malformations and brain tumors.

We are proud of these accomplishments and remain committed to quality and safety, the core strategies

that underlie our promise to provide the best possible outcomes and exceptional patient care. We keep

this promise top of mind as we continue to develop new programs and services, strengthen awareness of

and preference for MNI and expand our support of research and innovation.

Please feel free to contact us directly if you would like additional information about our services and programs.

With best wishes,

Dong h. Kim, M.D. DIRECTOR MISCHER NEUROSCIENCE INSTITUTE AT MEMORIAL HERMANN PROFESSOR AND CHAIR VIVIAN L. SMITH DEPARTMENT OF NEUROSURGERY UTHEALTH MEDICAL SCHOOL 713.500.6170

mhmni.com

Dr. Kim

Dr. Grotta

Dear Esteemed Colleagues,

1

James c. Grotta, M.D. CO-DIRECTOR MISCHER NEUROSCIENCE INSTITUTE AT MEMORIAL HERMANN PROFESSOR AND CHAIR DEPARTMENT OF NEUROLOGY UTHEALTH MEDICAL SCHOOL 713.500.7088

2

About Our Institute

3

Leading the way in neuroscience in a city known for medical excellence takes dedication. To accomplish

this, Memorial Hermann’s Mischer Neuroscience Institute brings together a team of world-class clinicians,

researchers and educators. A collaborative effort between Memorial Hermann-Texas Medical Center and

The University of Texas Health Science Center at Houston (UTHealth) Medical School, we are the largest

neuroscience provider in South Texas and one of only a few institutions in the country to provide all

aspects of neuroscience care, from neurology to neurosurgery to neurorehabilitation. This comprehensive

approach has led to the creation of Houston’s first and largest stroke team, its leading epilepsy and

neurotrauma programs, a cerebrovascular center that treats the the most aneurysms and arteriovenous

malformations in the region, and a brain tumor program that annually diagnoses and treats hundreds

of new tumor patients. We are proud of our innovations in multiple sclerosis, brain injury, spine surgery

and more. And we make more neuroscience breakthroughs every day.

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59

290

99

288

249

225

8

8

6

1010

45

45

610

Memorial HermannThe Woodlands

Memorial HermannNortheast

Memorial HermannMemorial City Medical Center

Memorial HermannTexas Medical Center

Memorial HermannSouthwest

Memorial HermannSugar Land

Memorial HermannSoutheast

Memorial HermannKaty

Memorial HermannNorthwest

Memorial HermannBaptist in Beaumont

Hospital

Hospital with Stroke Center

Hospital with Telemedicine

MNA Neurosurgeons

Center of Excellence

MNI’s infrastructure expansion has allowed the Institute to extend its neuroscience expertise and capabilities outside the Texas Medical Center and into the community through the development of neuroscience centers at Memorial Hermann community hospitals, creating five centers of excellence. Together, the centers bring distinctive subspecialty services to the community, and when combined with the specialized skills of neurosurgeons and neurologists at MNI, they offer suburban patients comprehensive consultation, evaluation and treatment for a range of disorders.

4

At-a-Glancephysician team

Staff Physicians 40 Clinical Residents and Fellows 39Medical Students on Rotation 252Research Fellows 7Advanced Practice Nurses 2Physician Assistants 15

inpatient Facilities

Total Neuro Beds 136Neuro ICU Beds 32Neuro Step Down Beds (IMU) 12Neuro Acute Care Beds 45Neuro Rehabilitation Beds 23Stroke Unit Beds 12Dedicated Operating Rooms 6EMU Beds – Pediatrics 6EMU Beds – Adult 6

research

Research Projects in Progress More than 200Grants Awarded $17 million

(Neurology and Neurosurgery)

specialty equipment

• LeksellGammaKnife®Perfexion™• SiemensArtis™zee(intra-operativeangiographysuite)• RP-7™RemotePresenceSystem• PhilipsHealthcareEndovascularTemperature

Modulation System• Simultaneouselectroencephalographyand

polysomnography• Magnes3600WHMagnetoencephalography

Brain Imaging System• MRIcapableofadvancedspectroscopicand

diffusion tensor imaging with tractotomy• VarianTrilogyLINACforStereotacticRadiosurgery

Neurology

0

5

10

15

20

25

30

Perc

ent M

arke

t Sha

rePe

rcen

t Mar

ket S

hare

Neurosurgery

MH-TMC Methodist St. Luke’s TCH Ben Taub Houston NW

MH-TMC Methodist St. Luke’s Ben Taub TCH UTMDA

0

2

4

6

8

10

12

14

Source: Texas Hospital Association Patient Data System (FY2009 Q1 – FY2011 Q4) provided by Thomson Reuters

Texas Hospital Inpatient Discharge Public Use Data File, [FY2007 Q1 – FY2011 Q1] provided by Texas Department of

State Health Services, Center for Health Statistics; Q2FY2011 – Q4 FY2011 discharges estimated by using historical

data by hospital. Excludes Normal Newborns and SNF. Expanded Greater Houston consists of 12 counties: Austin,

Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, San Jacinto, Waller, Walker and Wharton.

• ThefirstStrokeCenterinHoustonandoneof

the first dedicated stroke programs in the world.

• ThefirstandonlyhospitalintheTexasMedical

Center to receive state of Texas designation as

a primary stroke center.

• Thefirstcentertoconductanational,

multicenter trial for hypothermia in head injury.

• Thefirstneurosurgerycentertoofferall

advanced modalities of treatment – expert

microsurgery, interventional neuroradiology/

endovascular surgery and Gamma Knife® –

for complex lesions.

• TheNorthAmericanleaderinstudiesof

primary progressive multiple sclerosis and the

most active center in Texas in the conduct of

organized clinical trials of new therapies

for MS.

• ThefirstfacilityinHoustonandoneof

the first in the United States to test the

clot-dissolving drug tPA for acute stroke.

• ThefirstcenterinHoustontotestandprove

the efficacy of three disparate treatments

for stroke prevention: carotid surgery;

administration of antiplatelet drugs, including

aspirin; and patent foramen ovale closure.

• Thefirstfacilityintheregiontodovagus

nerve stimulation. We remain the No.1

program in the United States in the number

of vagal nerve stimulators implanted in

epilepsy patients.

• Broughtthefirstclinicalmagneto-

encephalography (MEG) sensor to Houston

and recently updated the technology to

the new Magnes 3600 WH. It remains the

only MEG in clinical use throughout Texas,

Louisiana, Arkansas and Oklahoma.

• OneofonlyafewinpatientEpilepsy

Monitoring Units in the country with

the unique capability of simultaneously

performing electroencephalography and

polysomnography.

• TIRRMemorialHermannistheonlycenter

in Houston – and one of only seven

designated centers in the nation – in the

Christopher and Dana Reeve Foundation

NeuroRecovery Network.

A History of Firsts

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6

Memorial Hermann has a longstanding commitment

to quality, safety and cost effectiveness. These are

also the three tenets of the University HealthSystem

Consortium (UHC), an alliance of 113 academic

medical centers and 254 of their affiliated hospitals,

representing approximately 90 percent of the nation’s

nonprofit academic medical centers. In 2010, the

organization ranked Memorial Hermann-Texas Medical

Center as No. 20 on its list of top academic medical

centers in the country. In an effort to continue to

improve patient care, Memorial Hermann-TMC is

committed to raising that ranking even higher.

“The UHC rankings are an objective measure of quality

and demonstrate a high standard of patient care,”

notes Dong H. Kim, M.D., director of the Mischer

Neuroscience Institute (MNI), chief of neurosurgery

at Memorial Hermann-TMC and chair of the Vivian L.

Smith Department of Neurosurgery at The University

of Texas Health Science Center at Houston (UTHealth)

Medical School. “At Memorial Hermann, quality and

safety are core strategies that underlie our commitment

to providing optimal clinical outcomes through patient-

centered care. To deliver on that promise, physicians

and staff at the Mischer Neuroscience Institute have

embraced a culture of accountability and innovation,

which has led to a relentless focus on continuous

improvement.”

Achieving Excellence in Quality, Safety and Cost Effectiveness

uhc’s core characteristics:

• Execution• Authenticity• Sustainability• Teamcollaboration• Intentionalactions

• Transparency• Inspiration• Professionalism• Safety• Community

FEAturE

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Improvements made by MNI in 2010 include decreases

in bloodstream infections, ventilator-associated

pneumonias, urinary tract infections and surgical-site

infections. All of these efforts have reduced costs and

enhanced quality and patient safety.

According to UHC, the nation’s top-performing academic

medical centers consistently embody a core set of

characteristics. These organizational traits include

a shared sense of purpose; a distinctive, interactive

leadership style; an accountability system for service,

quality and safety; a focus on results; and collaboration

among administrative leaders, clinical chairs and staff.

Memorial Hermann-TMC CEO Craig Cordola recently

set a new goal of achieving and maintaining a UHC

top-10 ranking. “To set the standard for quality patient

care in the future, we created a set of attributes that

we’ll use to characterize the way work is done, how staff

members treat one another and how care is delivered on

our Campus,” Cordola says. “Building on the Memorial

Hermann system’s core behaviors – accountable,

innovative, collaborative, compassionate, competent

and respectful – we’re seeking to incorporate 10 more

attributes: execution, authentic, sustainable, team,

intentional, transparent, inspired, professionalism,

safe and community. We’re confident that this new

vision will lead to new levels of quality, safety and

cost effectiveness.”

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The passage of two pieces of legislation, H.R. 3590,

the Patient Protection and Affordable Health Care Act in

December 2009, and H.R. 4872, the Reconciliation Act

of 2010 in March 2010, constitutes the largest change

in America’s healthcare system since the 1965 passage

of Medicare. It also marks the beginning of what will

be a long process of rulemaking and implementation,

with dozens of effective dates of major components of

reform scheduled over the next 10 years. While the law

will present challenges for healthcare providers across

the country—requiring resources and capabilities that

exceed those of most hospitals—Memorial Hermann is

well prepared for changes that will support and improve

quality care.

“As healthcare reform moves hospitals away from the

current model’s volume-driven, fee-for-service structure

to a pay-for-performance structure tied to clinical

outcomes, the Mischer Neuroscience Institute (MNI) is

examining processes and investigating opportunities

to improve efficiencies and quality,” says Dong H. Kim,

M.D., director of MNI, chief of neurosurgery at Memorial

Hermann-Texas Medical Center and chair of the Vivian

L. Smith department of Neurosurgery at The University

of Texas Health Science Center at Houston (UTHealth)

Medical School. “In line with our focus on innovation

and strategic planning, we’re committed to Memorial

Hermann’s ‘Creating a New Healthcare Model’ initiative,

which is redefining our organizational structure and

business model to ensure continued success in the

post-reform healthcare environment.”

Recently, the Centers for Medicare & Medicaid

Services (CMS) issued a proposed rule establishing

a hospital value-based purchasing program for acute

care hospitals for inpatient services provided to

Medicare beneficiaries. Under the proposed rule,

which was created to improve clinical outcomes and

patient satisfaction, hospitals will receive value-based

incentive payments beginning in fiscal year 2013,

based on clinical outcomes and patient satisfaction

with services provided.

“This change represents a dramatic shift in how

Medicare will pay hospitals,” says Jeffrey Katz, M.D.,

chief medical officer of the Memorial Hermann-TMC

Campus. “As part of the CMS Hospital Quality Initiative,

hospitals will be scored on quality measures and patient

satisfaction. CMS will designate hospitals in the top

50 percent as ‘top performers’ and they will receive

no cuts in reimbursement. Hospitals with measures

below the 50th percentile will face reductions in

reimbursement of 1 percent to 3 percent.”

Designing Our Future: Improving Efficiencies and Quality

FEAturE

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Closely related to the issue of value-based purchasing,

the federal government is seeking to regulate the

length of inpatient hospital stays. “We, and hospitals

across the nation, face a delicate balancing act in

the coming months and years as we seek to reduce

the time our patients spend in our hospital while also

effectively treating the whole person, which can include

multiple diagnoses,” Dr. Katz says. “This issue is a key

component of national healthcare reform, and therefore

remains a priority in all our service lines, including

Neuroscience.”

As with the potential for payment cuts related to

patient satisfaction, hospitals also will face negative

incentives for readmissions. Medicare has targeted

acute myocardial infarction, pneumonia and congestive

heart failure as areas in which to reduce readmissions.

Beginning in 2013, any patient with one of these

diagnoses who is readmitted within 30 days will trigger

a reduction of 1 percent of all Medicare reimbursements

to that hospital, which will increase to 2 percent in

2014 and 3 percent in 2015.

To thrive in the new post-reform environment and improve

clinical outcomes, hospitals and affiliated physicians will

need to be more closely aligned in healthcare delivery.

Memorial Hermann is working with its physician network,

MHMD, to create an Accountable Care Organization

(ACO) in which caregivers are held responsible for the

care they provide. ACOs reward hospitals and physicians

for delivering more efficient, coordinated quality care

founded on evidence-based medicine.

“Technology will be critical as we move toward more

coordinated, efficient quality care with the best clinical

outcomes,” Dr. Kim says. “Having our electronic medical

records and clinical decision support integrated with

computerized physician order entry, which uses order

sets built on evidence-based medicine, will help

contribute to improved care delivery. We continue to

improve our clinical documentation processes and

reduce our length of stay, which will help us improve

operations now and in the future.”

Quality and safety will continue to be important factors

in healthcare delivery as hospitals are held accountable

for hospital-acquired infections and complications that

result from unsafe care. Memorial Hermann is active

in a leadership role in the new Center for Transforming

Healthcare launched by The Joint Commission to develop

solutions that target patient safety and quality issues.

“We strive every day to increase efficiency of services

and enhance quality of care,” Dr. Katz says. “We will

continue to invest in the technology that enables our

physicians to treat illness in novel and innovative ways

and eliminates inefficient operational delays.”

As legislators continue to roll out new regulations

as part of national healthcare reform, MNI and

Memorial Hermann are prepared for the changes.

“Our commitment to quality is an integral part of who

we are as an institution,” Dr. Kim says. “We’re proud

of the terrific work of our physicians and researchers,

and of the impact they have on the lives of our patients,

and we’re confident that we’ll continue to provide the

highest level of care to our patients.”

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2011 Accolades

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We are proud to share with you highlights of our accomplishments in clinical care, research and academic endeavors as individuals and as an institution.

12

2011 Accolades

the Vivian L. Smith Department of Neurosurgery recognized for Academic Impact

The Vivian L. Smith Department of Neurosurgery at

The University of Texas Health Science Center at

Houston (UTHealth) Medical School was ranked 9th

and 12th nationally in a study of academic productivity

that appeared in the September 2010 issue of the

Journal of Neurosurgery1.

The authors of the article used the h index, a measure

of the number of citations received by a collection

of work, to estimate the relative academic impact

of 99 departments of neurosurgery with residency

programs participating in the U.S. National Residency

Matching Program, and 14 analogous Canadian

programs. Two lists of rankings were created: the first

tracked impact based on publication in neurosurgery

journals and the second tracked impact across all

neuroscience journals.

Among institutions cited in neurosurgery journals, the

UTHealth Medical School’s Neurosurgery department

ranked 12th nationally in a tie with the University of

Pennsylvania and the Cleveland Clinic Foundation.

In rankings tallied across all neuroscience journals, the

department was ninth nationally. These rankings are

the highest of any neurosurgery program in Texas.

“We’re proud of the work of our physicians and

researchers,” says Dong H. Kim, M.D., director of the

Mischer Neuroscience Institute and professor and chair

of the Vivian L. Smith Department of Neurosurgery

at the UTHealth Medical School. “These are terrific

rankings – the result of our shared commitment to

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advancing medical knowledge by reporting the results

of our basic science studies and participation in

clinical trials.”

Introduced in 2005 as a means of characterizing the

scientific output of a researcher, the h index is defined

as the number of papers, h, by an individual with

citation counts of h or higher. The number of times

an article has been cited by other works is often used

as a measure of impact, note the article’s authors.

They also reported significant correlations between

the citation indices and faculty size, number of

publications, types of degrees held by the faculty and

funding by the National Institutes of Health (NIH).

The Neurosurgery department ranks seventh nationally

in funded NIH grants.

1 Ponce FA, Lozano AM. Academic impact and rankings of American and Canadian neurosurgical departments as assessed using the h index. Journal of Neurosurgery 113:447-457, 2010.

James Grotta, M.D., Honored with Academic Mentorship Award and Named Health Care Heroes Finalist

The American Heart Association presented one of

its highest honors, the Eugene Braunwald Academic

Mentorship Award, to James C. Grotta, M.D., chief

of neurology at Memorial Hermann-Texas Medical

Center, co-director of the Mischer Neuroscience

Institute (MNI) and professor and chair of the Neurology

department at The University of Texas Health Science

Center at Houston (UTHealth) Medical School. He was

recognized for exceptional achievement in guiding

and inspiring young trainees throughout his career in

research and administration.

Dr. Grotta received the award during opening

ceremonies of the American Heart Association’s 2010

Scientific Sessions held last November in Chicago.

“The award is a testament to your long and distinguished

career – and a real compliment to your record of

mentoring young researchers who will help push the

scientific community toward neurological breakthroughs

for many years to come,” wrote American Heart

Association executive vice president Midge LaPorte

Epstein in an announcement letter. “Your impact in the

field will no doubt be felt long after your own time in

the laboratory is finished.”

The Eugene Braunwald Academic Mentorship Award

followed Dr. Grotta’s selection as a 2010 “Health Care

Heroes” finalist by the Houston Business Journal.

The Health Care Heroes Awards are presented annually

to honor those who serve, innovate and save lives.

Dr. Grotta, who holds the Roy M. and Phyllis Gough

Huffington Distinguished Chair, has played a

leadership role in many clinical research studies of

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2011 Accolades

both thrombolytic drugs and cytoprotective agents

following stroke, and has been funded by the National

Institutes of Health (NIH) for laboratory studies on the

biology of brain injury and recovery in animal stroke

models. He is currently funded by the NIH for a project

to carry out a series of novel pilot studies aimed at

amplifying the existing benefits of intravenous tPA

and achieving clinically meaningful neuroprotection

using hypothermia.

In 1988, Dr. Grotta was instrumental in founding

MNI’s Stroke Center, one of the first dedicated stroke

programs in the world and the first Joint Commission-

accredited primary stroke center in the region. Under

his leadership, Memorial Hermann-TMC was the first

in Houston and one of the first in the United States to

test tPA for acute stroke.

Dr. Grotta orchestrated the development of a highly

successful collaborative network between the MNI

Stroke Center, Memorial Hermann-TMC, Houston Fire

Department Emergency Medical Services and other

regional stroke centers to increase the delivery of

appropriate therapy to a large number of acute stroke

patients in Houston. As a result, the Stroke Center

remains the American leader in number of acute

stroke patients treated with tPA, with an administration

track record of 10 times the national average. He has

extended these efforts to rural areas through regional

educational programs and, more recently, telemedicine.

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Dr. Grotta also directs an NIH-funded and Accreditation

Council for Graduate Medical Education-accredited stroke

training program with a strong emphasis on basic and

clinical research. He has assembled a multidisciplinary

stroke faculty that has graduated more than 40 clinician-

scientists specializing in stroke research.

He has been an editor of the Annals of Neurology, Stroke

and many other peer-reviewed journals, and a member

of several NIH and FDA review panels. He was a recipient

of the Feinberg award for Excellence in Clinical Stroke

from the American Heart Association in 1999, the AHA

Physician of the Year Award for 2006 and awards for

teaching excellence at the UTHealth Medical School

for 14 years. He has authored or co-authored more than

200 articles in peer-reviewed journals.

Neuromuscular Disorders Center Designated GBS/CIDP Center of Excellence

The GBS/CIDP Foundation International has designated

the Neuromuscular Disorders Center at Mischer

Neuroscience Institute (MNI) and The University of

Texas Health Science Center at Houston (UTHealth)

department of Neurology as a center of excellence for

the diagnosis and treatment of Guillain-Barré syndrome,

chronic inflammatory demyelinating polyneuropathy

(CIDP) and other inflammatory peripheral neuropathies.

The designation was awarded in recognition of the

high standards maintained and quality of patient care

provided at the center, which is one of only six such

centers of excellence in the United States.

The MNI neuromuscular disorders team includes Kazim

Sheikh, M.D., professor of neurology at the UTHealth

Medical School, director of the MNI Neuromuscular

Disorders Center and director of the Muscle and

Nerve Laboratory at Memorial Hermann-Texas Medical

Center; Parveen Athar, M.D., assistant professor of

neurology and director of the MNI Electromyography

Laboratory; and Suur Biliciler, M.D., assistant professor

of neurology, all of whom provide adult care.

Pedro Mancias, M.D., a member of the medical staff at

Children’s Memorial Hermann Hospital and an associate

professor of pediatric neurology, provides pediatric care.

Andrew Barreto, M.D., Graduates from Physician Quality & Safety Leadership Academy

Andrew Barreto, M.D., assistant professor of neurology

at The University of Texas Health Science Center at

Houston (UTHealth) Medical School, was among seven

graduates in the second class of the Physician Quality

& Safety Leadership Academy, a collaborative effort

of Memorial Hermann-Texas Medical Center and the

UTHealth Medical School. The Academy was created

in 2008 to build a core group of physician leaders

considered experts in this arena.

Dr. Barreto was nominated for the Academy by

Neurology department chair James C. Grotta, M.D.,

co-director of the Mischer Neuroscience Institute.

Highlights of the nine-month course included immersion

in Six Sigma methodology and LEAN process, and

the opportunity to interact with nationally renowned

physician quality advocates, including Brent James,

M.D., and Jim Reinertsen, M.D.

Projects were selected in conjunction with Academy

leaders, and the results of the physicians’ work were

presented at the Academy’s graduation ceremony.

Dr. Barreto’s project was titled “Time to Intra-arterial

Therapies for Stroke Patients.”

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2011 Accolades

Nicole Gonzales, M.D., receives Young Investigator’s Award

Nicole R. Gonzales, M.D., was honored at the 5th

Annual Young Investigator’s Appreciation Luncheon to

recognize the research achievements of junior faculty


Houston (UTHealth) Medical School. Her work was

recognized by Larry R. Kaiser, M.D., F.A.C.S., former

president of UTHealth Medical School.

Dr. Gonzales is principal investigator of “The Safety of

Pioglitazone for Hematoma Resolution in Intracerebral

Hemorrhage (SHRINC) and MRI Evaluation of Hematoma

Resolution as a Surrogate Marker of Clinical Outcome in

Intracerebral Hemorrhage.” The study compares the

safety of pioglitazone with standard of care for patients

with spontaneous intracerebral hemorrhage. The hope

is that the drug can stimulate the body’s own cells to

absorb the hematoma faster and, as a result, lead to

more rapid recovery.

Neurosurgery Chief resident recognized by the Gold Foundation

Neurosurgery chief resident Bart MacDonald, M.D.,

is among six residents at The University of Texas Health

Science Center at Houston (UTHealth) Medical School

to receive the Arnold P. Gold Foundation’s Humanism

and Excellence in Teaching Award. Nominated by

fourth-year medical students, he was recognized for

his compassion and empathy in the delivery of care to

patients and for illustrating professional behavior.

Dr. MacDonald received his medical degree from

the Medical College of Georgia in Augusta in 2000,

followed by an internship in general surgery at the

University of Florida in Gainesville. He completed his

first year of neurosurgical residency at the University of

North Carolina in Chapel Hill in 2001, followed by four

years at Brigham and Women’s Hospital and Children’s

Hospital in Boston, where he also conducted research

in hydrocephalus. His clinical and research interests

include complex spine and vascular neurosurgery.

The Arnold P. Gold Foundation advances humanism

in medicine, perpetuating the tradition of the caring

doctor.

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Patients from around the world choose to receive treatment at the Mischer Neuroscience Institute based on our high-quality

outcomes and our reputation for providing the best possible healthcare experiences, both of which are supported by our

commitment to communication and responsiveness. Data gathered by the Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS) survey shows consistent improvement in domains considered critical to ensuring a high

level of patient satisfaction.

Source: Press Ganey, national hospital survey vendor, for all surveys received from patients discharged from 3 Jones, 7 Jones/

NSICU, 4 Jones/NIMU/Stroke and EMU

HCAHPS scores have not been adjusted to account for a survey mode administration change

Patient Experience

0

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DischargeInformation

DoctorCommunication

NurseCommunication

Pain Management HospitalEnvironment

CommunicationNew Medications

Responsivenessof Staff

Perc

ent (

%)

FY 08 FY 09 FY 10 FY 11

HCAHPS Domains of Care

Surveys Received FY08-11Respondents choosing “always” or “yes”

76%79% 79% 81%

74%78%

73%76%

68% 67%71% 70%

61% 61%65% 65%

58% 56%

61% 62%

52% 52%55% 55%

46% 48%

56% 56%

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Scope of Services

Brain tumor

20

SCOPE OF SErVICES

With the arrival of fellowship-trained neurologist and

neuro-oncologist Jay-Jiguang Zhu, M.D., Ph.D., in

September 2010, the Mischer Neuroscience Institute

(MNI) added significant strength to its Brain Tumor

Center. Dr. Zhu joined MNI from Boston, where he

trained at Massachusetts General Hospital and served

on the faculty of Tufts University. He focuses his practice

on primary brain tumors – gliomas, meningiomas and

pituitary adenomas – and primary CNS lymphomas, as

well as brain metastases and leptomeningeal spread

of systemic malignancies. He is also interested in

quality of life, including cognitive function during and

after radiotherapy and chemotherapy; neurological

complications of systemic chemotherapies; and clinical

trials focused on developing new treatment options for

primary brain tumors and CNS metastasis. He currently

serves as principal investigator in three trials that give

eligible study participants access to new and advanced

treatments.

The first is a Phase III, multicenter, randomized,

controlled trial designed to test the efficacy and safety

of a medical device called Novo TFF-100A for newly

diagnosed glioblastoma multiforme (GBM) patients

in combination with temozolomide, compared to

temozolomide alone. The device, which patients wear

on their scalp, emits a constant, safe, low-voltage

signal that has been shown to reduce tumor cell

survival and division capacity. The Novo TFF-100A

was recently approved by the FDA for the treatment

of progressive GBM; the trial is open to newly

diagnosed GBM patients. Dr. Zhu is also principal

investigator in a trial of Azixa™ (verubulin), an

investigational cancer drug being developed for

the treatment of newly diagnosed GBM patients.

A randomized, double-blind, controlled Phase IIB

clinical trial of the safety and efficacy of the vaccine

ICT-107 for newly diagnosed GBM patients following

resection and chemoradiation has been approved,

and began enrollment in August 2011.

Our team focuses on providing the best state-of-the-

art treatment and access to investigational trials

as appropriate. We use innovative and advanced

technologies, including motor and language mapping,

functional neuroimaging, frameless stereotactic

navigation in surgery, and awake craniotomies

performed under local anesthesia. We also

perform minimally invasive procedures, including

neuroendoscopy and stereotactic radiosurgery.

21

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After acquiring the region’s first Leksell Gamma Knife® in

1993, we recently acquired the most advanced Leksell

Gamma Knife Perfexion™. Patients who benefit from the

Perfexion’s sophisticated software with dose-to-target

conformation include those with meningiomas and

vestibular schwannomas; arteriovenous malformations;

medically refractory trigeminal neuralgia; and

metastases. Multiple intracranial metastases can

usually be treated in a single outpatient procedure.

Our clinical team works closely with referring physicians

throughout the Gamma Knife treatment process.

A neurosurgeon and a radiation oncologist assess

each candidate to determine whether radiosurgical

treatment is the best option. Our Gamma Knife nurse

navigators work directly with patients on scheduling and

pretreatment education, and provide support and care

on the day of treatment.

Breakthrough approaches to treatment at MNI are

allowing us to grow the number of patients treated

for brain tumors. At the same time, our mortality rate

and average length of stay are well below the national

benchmark established by the University HealthSystem

Consortium.

050

250

150

350

200

100

300

400

20092008 2010 2011

0

2

6

4

8

10

20092008 2010 2011

Actual Expected Number of Encounters

Brain Tumor (all types): Length of Stay

Actual Expected

Brain Tumor (all types): Inpatient Mortality

Number of Encounters

Brain Tumor Volume

0

2

4

6

8

10

12

20092008 2010 20110

100

200

300

400

Volu

me

Bette

r tha

n ex

pect

edBe

tter t

han

expe

cted

Source: chart data based on ICD9 codes, per fiscal year



QuALItY & OutCOMES MEASurES

SCOPE OF SErVICES

22

Opened in 1988 as one of the first dedicated stroke

programs in the world, Mischer Neuroscience Institute’s

Stroke Center is home to the 10-county Greater Houston

area’s largest onsite stroke team. Neurologists at the

Center use leading-edge technology to diagnose and

treat more than 1,000 patients annually, ensuring that

each patient gets the appropriate treatment as quickly

as possible. By working closely with the Houston Fire

Department and local EMS services, our stroke team

has logged an impressive record of success in the

administration of tPA – more than 10 times the national

average of 2 percent.

In 2010, The Joint Commission re-credentialed Memorial

Hermann-Texas Medical Center as a comprehensive

stroke center, the highest designation offered by the

organization. Two Memorial Hermann hospitals earned

The Joint Commission’s Gold Seal of Approval™ for

Primary Stroke Centers, and three facilities were named

Community Stroke Support Facilities. In addition, the

state of Texas designated Memorial Hermann-TMC as

a primary stroke center, making us the first hospital in

the Texas Medical Center to receive this designation.

Our Telemedicine Program extends our stroke and

neurology expertise far beyond our walls, helping

emergency physicians in community hospitals

throughout southeast Texas make accurate diagnoses

and save lives. Remote presence robotic technology

has enhanced MNI’s telemedicine program by linking

outlying hospitals electronically to the Neurology

department, providing real-time visual interaction

between neurologists and patients, and allowing

MNI neurologists to review CT scans and advise

local physicians on treatment outcomes. Through

telemedicine, we can now offer patients in outlying

Cerebrovascular

23

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0

2500

1500

2000

1000

500

2008 2009 2010 2011

0

2

6

4

8

10

12

2008

Volu

me

2009 201120100

400200

6008001000

14001200

0

2

6

4

8

10

12

20092008 2010 2011

0

2

4

1

3

5678

20092008 2010 20110

500

1000

0

5

15

10

20

20092008 2010 2011

0

6

2

108

4

1214

20092008 2010 20110

100

200

50

150

02

64

8

141210

20092008 2010 2011

Acute Ischemic Stroke: Length of Stay

Actual

Cerebrovascular Volume


Expected

Acute Ischemic Stroke: Inpatient Mortality

Actual ExpectedNumber of Encounters

Intracranial Hemorrhage: Length of Stay

Actual Expected

Acute Ischemic Stroke: Inpatient Mortality


Aneurysm Unruptured: Length of Stay

Actual Expected

Aneurysm Unruptured: Inpatient Mortality


Bette

r tha

n ex

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ed

Bette

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pect

ed

Volu

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Volu

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Bette

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pect

ed

Source: chart data based on DRGs, per fiscal year



Source: chart data based on DRGs, per fiscal year


Source: chart data based on DRGs and ICD9 codes, per fiscal year


Cerebrovascular

24

communities an opportunity to participate in clinical

trials that would otherwise be unavailable to them,

which expands medical knowledge as it saves lives.

In addition to breakthrough treatment for stroke, our

cerebrovascular team provides coordinated care for

patients with aneurysms, carotid occlusive disease

and intracranial vascular malformations, including

endovascular treatment. Procedures include angioplasty,

stenting and embolization. Radiosurgery is also available

for vascular malformations. Our neurosurgeons are skilled

at clot retrieval, hemicraniectomy for severe strokes,

microvascular clipping of aneurysms, endovascular

embolization, extracranial-intracranial bypass and

carotid endarterectomy.

We conduct more research than any other center in

the south or southwestern United States, participating

in multicenter and single-center clinical trials that

improve treatments for patients who cannot be treated

elsewhere. Research under way includes thrombolytic

treatment for wake-up stroke, the safety of pioglitazone

for hematoma resolution in intracerebral hemorrhage

and the safety of autologous bone marrow cell treatment

for acute ischemic stroke. Investigators are also seeking

to increase the effect of standard-of-care treatment

by combining tPA with ultrasound, anticoagulants and

hypothermia, as well as exploring new methods of stroke

prevention that include carotid artery stenting and

patent foramen ovale closure.

We extend our cerebrovascular continuum of care through

inpatient and outpatient neurorehabilitation in Memorial

Hermann-TMC’s 23-bed rehabilitation unit and at TIRR

Memorial Hermann, a top-tier, 119-bed rehabilitation

hospital. Patients benefit from comprehensive inpatient

and outpatient services, state-of-the-art technology and

innovative therapies and techniques.


Clinical Measure Measure Description2010

National Average

GWTG Stroke Performance Measure Goal

2007 2008 2009 2010

DVT prophylaxis

Ischemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission.

88.1% 85.0% 93.3% 98.3% 100% 98.8%

Antithrombotics at discharge

Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge. 98.7% 85.0% 97.5% 98.0% 96.9% 96.9%

Anticoagulation for atrial fibrillation

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge.

95.4% 85.0% 100% 96.9% 100% 100%

IV tPA use (eligible < 2 hour arrival)

Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV tPA was initiated at this hospital within 3 hours of time last known well.

71.5% 85.0% 100% 100% 100% 99.2%

Early antithrombotics (<48 hour arrival)

Ischemic stroke patients administered anti-thrombotic therapy by the end of hospital day 2. 97.3% 85.0% 96.5% 100% 99.0% 100%

Lipids measure (statin at discharge)

Ischemic stroke patients with LDL >= 100 mg/dL, or LDL not measured, or who were on a lipid-lowering medication prior to hospital arrival, are prescribed statin medication at hospital discharge.

92.5% 85.0% 88.7% 88.1% 87.1% 87.8%

Cerebrovascular

stroke core Measures

Source: chart data based on calendar year

SCOPE OF SErVICES

25

mhmni.com

The Texas Comprehensive Epilepsy Program is the

only Level IV National Association of Epilepsy Centers-

certified program in Houston. A collaborative effort

between Memorial Hermann-Texas Medical Center,

Children’s Memorial Hermann Hospital and The

University of Texas Health Science Center at Houston

(UTHealth) Medical School, we are the leading program

in the southwestern United States for the diagnosis

and treatment of epilepsy in patients of all ages.

The number of patients we treat annually continues

to grow. Today, our board-certified neurologists and

neurosurgeons diagnose and treat more than 350

pediatric and adult patients each year for seizures

and epilepsy. Genetics, brain trauma, structural

abnormalities, stroke and brain tumor rank among

the top underlying causes, but because epilepsy and

other types of seizures manifest differently among

individuals, determination of the origin of seizures is

crucial to planning the most effective treatment.

Epilepsy

Phot

o Co

urte

sy o

f Niti

n Ta

ndon

, M.D

.

Epilepsy SCOPE OF SErVICES

26

Our full suite of diagnostic tools includes

magnetoencephalography (MEG) to map neurological

function, video EEG, 3-Tesla structural MRI, functional

MRI and tractography, PET and SPECT, memory and

speech (Wada) testing and neuropsychological testing.

We are a national leader in combining the use of

MEG and functional MRI to map the brain and record

brain activity, and we remain the only center in Texas,

Louisiana, Arkansas and Oklahoma to offer this service

since bringing the first MEG imager to Houston in 1997.

Each year, we perform more than 150 noninvasive

MEG procedures on pediatric and adult patients.

We are also one of only a few inpatient units

in the country with the capability to perform

electroencephalography and polysomnography

simultaneously.

Once a diagnosis is made, we offer the most advanced

treatment options available, including drug therapy, the

ketogenic diet, vagus nerve stimulation (VNS), focal

cortical resection, lobectomy, hemispherectomy and

corpus callosotomy. We also go beyond diagnosis and

treatment of epilepsy by counseling patients in ways to

cope with their diagnosis. Specialized counselors ensure

that recently diagnosed patients have the emotional

support they need.

Our team has been involved in research related to most

epilepsy treatments approved in the United States in the

last 15 years, including a number of drug and intravenous

therapies and VNS therapy. Current research includes

lacosamide monotherapy and adjunctive therapy for

partial-onset seizures, the epilepsy phenome/genome

project, oxygen-enhanced magnetic resonance imaging in

non-lesional focal epilepsy and a quantitative analysis of

the electroencephalogram in epilepsy.

the texas Comprehensive Epilepsy Program diagnoses and treats more than 350 pediatric and adult patients annually for seizures and epilepsy. thanks to advanced diagnostic tools that allow us to localize the origin of seizures and map brain function, the number of MNI patients who benefited from successful resective surgeries increased in fiscal year 2011.

Epilepsy Volume

0

50

250

150

350

200

100

300

450

400

20092008 2010 2011


Source: chart data based on DRG codes, per fiscal year

27

mhmni.com

Phot

o Co

urte

sy o

f Niti

n Ta

ndon

, M.D

.

SCOPE OF SErVICES

28

Memory Disorders and Dementia Physicians in the Memory Disorders and Dementia

Program at the Mischer Neuroscience Institute are

dedicated to evaluating and treating persons with

cognitive and behavioral changes, and performing

cutting-edge research into the diseases that produce

these disorders.

Dementias are a group of disorders that impair thinking

or behavior in more than two spheres, such as memory,

language, finding one’s way around, a change in

personality or a change in behavior. For a diagnosis of

dementia, these changes must have a significant impact

on a person’s daily life, such as impairing the ability

to work. We treat all the known causes of dementia,

including infections, trauma, medications, vitamin or

hormone deficiencies, vascular disease and strokes.

The condition can also be caused by neurodegenerative

disorders in which brain cells die without an obvious

cause, such as Alzheimer’s disease (AD), frontotemporal

dementia (FTD) and Parkinson’s disease. The number

of persons affected by dementia is enormous: AD alone

affects more than 5.3 million Americans.

Physicians in the MNI Dementia Program perform

advanced research focused on developing ways

to provide early diagnosis and treatment for these

devastating illnesses. Our investigations are directed at

determining which individuals will develop dementia,

finding accurate tools to diagnose dementia and

determine the type of dementia from which a person

suffers, and finding ways to stop the progression of

dementing illnesses.

Our Presymptomatic Diagnosis and Treatment of

Dementia Clinic is dedicated to reducing the risk of

developing dementia and to developing new diagnostic

and treatment tools. Our team has identified multiple

risk factors for dementia, including family history,

head trauma that produces a loss of consciousness,

high blood pressure, high cholesterol or triglycerides,

diabetes, obesity, smoking, post-traumatic stress disorder

and many others. At the clinic, physicians evaluate

individuals at risk for dementia who are asymptomatic,

and treat their risk factors. We have shown that risk

factor reduction is associated with a dramatic decrease

in a person’s risk for developing dementia. We are also

investigating new treatments to delay or ameliorate the

development of dementia. We believe that treatment

interventions will be much more effective if introduced

early in the molecular cascade of events that lead to

these diseases. Because early diagnosis is critical, we

are investigating tools to accomplish that. Currently there

are no diagnostic tests for dementia, much less before

symptoms develop.

Our laboratory partner in developing new treatments is

the George P. and Cynthia W. Mitchell Center for Research

in Alzheimer’s Disease and Related Brain Disorders.

29

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Investigators take findings from our clinical studies to their

laboratory and use animal models to investigate how risk

factors dramatically increase the probability of developing

these diseases. They are identifying additional biomarker

changes in animals that can be studied in humans

and testing for medications that are effective against

these diseases. They also recently identified a potential

infection basis to Alzheimer disease in mice that we are

now investigating clinically. Our other goal is to translate

medication discoveries in animals to human trials to

establish new preventive treatments.

The second most common neurodegenerative disorder

is frontotemporal dementia. It is intimately associated

with amyotrophic lateral sclerosis (ALS), a devastating

disorder that produces progressive weakness to the point

of death. Our Frontotemporal Dementia Clinic is dedicated

to determining the environmental and genetic causes of

these disorders, and developing treatments for them.

Over the last two decades, researchers have discovered

that several psychiatric syndromes have a neurologic

basis, including bipolar disorder, schizophrenia, major

depressive disorder and post-traumatic stress disorder

(PTSD). It has also become apparent that neurologic

disorders can produce symptoms that are identical

to those associated with those psychiatric disorders.

In our Neuropsychiatry and Behavioral Neurology

Clinic, we evaluate patients to determine whether their

neuropsychiatric symptoms are due to neurologic or

psychiatric disorders, and treat their disorders or make

appropriate referrals. A major focus of the research

component of this clinic is traumatic brain injury (TBI)

and PTSD. Together with the Center for Translational

Injury Research, we are investigating treatments for TBI

and the causes, treatments, and prevention of PTSD.

By using sophisticated new technologies to study these

disorders at the cellular and clinical levels, we hope to

realize our goal of diagnosis before patients become

symptomatic with dementia and to find new treatments

to prevent dementia.

30

priNcipal iNvestiGator: Paul Schulz, M.D., Associate Professor, Department of Neurology, and Director

of the Memory Disorders and Dementia Clinics, The University of Texas Health Science Center at Houston

(UTHealth) Medical School

Very little is known about the medical and environmental risk factors associated with frontotemporal dementia

(FTD). In this study, researchers evaluated medical and environmental disorders associated with FTD in a

population of 845 veterans seen over a five-year period. They concluded that there is a significant increase

in the risk of developing FTD in patients with traumatic brain injury. FTD also appears to be associated with a

decrease in heart disease, suggesting an underlying metabolic change.

Medical and environmental risk Factors associated with FrontotemporalDementia: a case-control study in a veteran population

adjusted odds ratios and 95% confidence intervals for associationof medical and environmental factors with FtD

Movement Disorders and Neurodegenerative Diseases

Model 1 Model 2

all dementias all dementias except vascular Dementia (vaD)

OR (95%CI) p OR (95%CI) p

heart disease 0.4 (0.3-0.96) 0.040 0.4 (0.2-0.98) 0.047

cerebrovascular diseases 0.5(0.2-1.1) 0.095

traumatic brain injury 4.4 (1.6-11.8) 0.003 3.8 (1.4-10.2) 0.008

Memory Disorders and DementiarESEArCH HIGHLIGHt

Model 1: included all patients with dementias. The covariates were age, TBI, heart disease, cerebrovascular disease and anemia.

Model 2: included all patients with dementias except VaD. The covariates included those in model 1 except cerebrovascular disease.

31

mhmni.com

SCOPE OF SErVICES


Using pioneering techniques to diagnose, evaluate,

manage and treat adult and geriatric patients, the


Program has established a track record of providing

outstanding care with excellent outcomes. Our medical

team uses proven and investigational medications and

interventional methods to manage Parkinson’s disease,

Parkinsonian disorders, generalized and focal dystonia,

essential tremor, Huntington’s chorea, Alzheimer’s

disease, cortical and subcortical dementias, cerebral

palsy, spasticity, ataxias, gait disorders, spinal and

brain trauma-related movement abnormalities, multiple

sclerosis-related movement abnormalities and other

inherited and acquired neurodegenerative diseases.

Our treatment philosophy is grounded in the

early identification of disease and early use of

neuromodulating or neuroprotective approaches.

We maintain patients at the highest level of function

possible, based on symptom-driven therapeutic

goals set by physician and patient. In developing and

adjusting our treatment plans, we consider the whole

person, as well as the patient’s environment and

support groups. We also emphasize education, and

encourage patients to stay mentally and physically

active and to have fun.

Our deep brain stimulation (DBS) program for

Parkinson’s tremor, dystonia and essential tremor is

known for low complication rates and outstanding

outcomes. Based on the skill of our neurological

and neurosurgical teams and our expertise in DBS

programming, we advocate for early use of deep brain

stimulation in appropriate patients.

The Movement Disorders and Neurodegenerative

Diseases Program is a collaborative effort of the

Mischer Neuroscience Institute and UT MOVE, with

specialty clinics that include Spasticity Management,

DBS Selection and Programming, Botox® Injection

and Intrathecal Baclofen Pump Therapy. Because

rehabilitation is integral to our outcomes, we work

closely with the physical and occupational therapists

and speech-language pathologists in our inpatient and

outpatient clinics and at TIRR Memorial Hermann to

research new approaches to improving treatment.

33

mhmni.com

rESEArCH HIGHLIGHt

priNcipal iNvestiGator: Mya Schiess, M.D., Professor and Adriana Blood Chair in Neurology, Director of the

Movement Disorders Clinic and Director of UT MOVE at The University of Texas Health Science Center at Houston

(UTHealth) Medical School

co-priNcipal iNvestiGator: Timothy Ellmore, Ph.D., Assistant Professor, Vivian L. Smith Department of

Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth) Medical School.

Dr. Schiess and her research team sought to determine whether resting-state functional MRI (fMRI) connectivity

of the substantia nigra (SN) distinguishes REM sleep behavior disorder patients from patients diagnosed with

early Parkinson’s disease. Data from the clinical trial show that SN-putamen temporal coherence, as measured

by resting-state fMRI, decreases from control to REM sleep behavior disorder to early Parkinson’s disease

groups. The researchers concluded that this functional connectivity metric may be useful for tracking disease

progression and/or predicting Parkinson’s onset.

substantia Nigra rest state fMri correlation Differences Between reM sleep Behavior and early pD patients

rBD vs. epD correlation comparison

0

20

10

30

70

60

50

40

0

20

10

30

70

60

50

40

CaudatePutamen Pallidum Thalamus CaudatePutamen Pallidum Thalamus

# vo

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LSN Seed RSN Seed

Left Right Left Right


rESEArCH HIGHLIGHt

34

significant Within-Group correlation


0

80

60

40

20

100

180

160

140

120

RBDCON EPD

LSN Seed

# vo

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(p<0

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0

80

60

40

20

100

180

160

140

120

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RSN Seed

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(p<0

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Left Putamen Right Putamen Left Putamen Right Putamen

35

mhmni.com

The Mischer Neuroscience Institute’s Multiple Sclerosis

Program has established a track record of cutting-edge

care using groundbreaking techniques to diagnose,

evaluate, manage and treat adult patients with MS

and other demyelinating disorders. Our scope of

expertise is broad and includes patients in all

stages of MS, as well as those with neuromyelitis

optica, transverse myelitis and optic neuritis. We are

experienced in the appropriate use of aggressive

therapies in severe cases.

Organized in 1983, the Multiple Sclerosis Research

Group (MSRG) has participated in numerous clinical

trials of novel disease-modifying therapies, serving as

the lead center for numerous international studies,

several of which were pivotal in gaining FDA approval of

currently available treatments for MS. Recent research

includes participation in two clinical trials of the new drug

fingolimod as the first oral agent approved by the FDA for

the treatment of MS, an important addition to available

therapies for the management of relapsing forms of

multiple sclerosis. Investigators in the MSRG are also

engaged in a National Institutes of Health-sponsored trial

of combined therapy in early relapsing MS and a National

MS Society-sponsored study of chronic cerebrospinal

vascular insufficiency (CCSVI).

Multiple Sclerosis

SCOPE OF SErVICES

36

tensor imaging with tractotomy, as well as other advanced

diagnostic tools. Following diagnosis, patients benefit

from breakthrough treatment options that include

injectable immunomodulators, immunosuppressives and

other agents designed to treat the debilitating symptoms

of MS. Investigators also use the MRI Analysis Center

to monitor the effects of promising oral drugs in pivotal

efficacy trials.

Our goal is to maintain our patients at the highest level of

function possible, with early use of immunoactive agents

to prevent disease progression. Because rehabilitation is

integral to each patient’s treatment plan, we work closely

with the physical medicine and rehabilitation specialists

and therapists at TIRR Memorial Hermann, as well as the

neurorehabilitation team at MNI.

We were the first center in the world to conduct

preclinical studies on the effects of combined therapy

with immunomodulating drugs and to explore the effects

of oral cytokines in modulating MS and Type 1 diabetes.

We are the first and only center in Houston to direct

national and international clinical trials in MS, and we

remain the North American leader in studies of primary

progressive multiple sclerosis, as well as the most active

center in Texas in the conduct of organized clinical

trials of new therapies for MS. Our physicians are at the

forefront of investigator-initiated research in immune

regulation in MS, infection as a cause of MS, MS-related

cognitive impairment and MS-related MRI findings.

In our state-of-the-art Magnetic Resonance Imaging

Analysis Center, we use spectroscopic and diffusion

Multiple Sclerosis SCOPE OF SErVICES

37

mhmni.com

priNcipal iNvestiGator: Jerry Wolinsky, M.D., Bartels Family and Opal C. Rankin Professor of Neurology, Director of

the Multiple Sclerosis Research Group (MSRG) and Director of the Magnetic Resonance Imaging Analysis Center at The

University of Texas Health Science Center at Houston (UTHealth) Medical School

In this international clinical trial, researchers reported additional MRI outcomes from TEMSO, a randomized, double-

blind, placebo-controlled, parallel-group study of 1,088 subjects. Patients were randomized to placebo or teriflunomide,

a novel oral disease-modifier in development for multiple sclerosis with relapses, once daily for 108 weeks. MRI

scans were performed at baseline and at weeks 24, 48, 72 and 108. As was previously reported in the TEMSO trial,

teriflunomide was superior to placebo across a range of MRI parameters over the 108-week study, with evidence of

significantly reduced disease activity and severity. The researchers concluded that significant reductions in relapse rate

and disease progression, as well as a favorable safety profile, support a role for teriflunomide as an effective potential

first-line oral monotherapy for MS with relapses.

Wolinsky JS, O’Connor P, Confavreux C, Comi G, Kappos L, Olsson TP, Truffinet P, Wang L, Miller A, Freedman M

(2011) A placebo-controlled phase III trial (TEMSO) of oral teriflunomide in multiple sclerosis with relapses: Additional

magnetic resonance imaging (MRI) outcomes. Neurology 76(S4):A545-6.

Num

bero

fT1-

Gd

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spe

rsca

n

RRR: relative risk reduction

Teriflunomide TeriflunomidePlacebo 7 m 14 mg

RRR: 80.4%(p<0.001)

RRR: 57.2%(p<0.001)

1.4

1.2

1

0.8

0.6

0.4

0.2

0

1.331

0.570

0.261 Prop

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-free

(%)

Placebo 7 mg 14 mg

p<0.0001

p<0.001

70

60

50

40

30

20

10

0

39.0

51.4

64.1

Data from “A Phase III, Placebo-controlled Trial of Oral Teriflunomide in Relapsing Multiple Sclerosis: Magnetic Resonance Imaging Outcomes.” Wolinsky J, O’Connor P, Confavreux C, Comi G, Kappos L, Olsson T, Truffinet P, Wang L, Miller A, Freedman MS. USA Session: Late-Breaking News, presented at the 26th Congress of the European Committee for Treatment and Research in Multiple Sclerosis.

(A) (B)

a phase iii, placebo-controlled trial (teMso) of oral teriflunomide in Multiple sclerosis with relapses: additional Magnetic resonance imaging outcomes

Number of gadolinium(Gd)-enhancing t1 lesions per scan(a) and proportion of patients free from Gd-enhancing t1 lesions(B).

Movement Disorders and Neurodegenerative Diseases rESEArCH HIGHLIGHt Multiple Sclerosis

O’Connor, P, JS Wolinsky, et al. (2011). “randomized trial of Oral teriflunomide for relapsing Multiple Sclerosis.” New England Journal of Medicine 365(14): 1293-1303.

SCOPE OF SErVICES

38

Neuromuscular Disorders

Physicians affiliated with the Mischer Neuroscience

Institute’s Neuromuscular Disorders Program are

subspecialized in complex neuromuscular disorders

that are difficult to diagnose and treat, including

neurodegenerative disorders, inflammatory nerve and

muscle disorders, autoimmune neuromuscular junction

disorders, traumatic nerve injuries and toxic metabolic

disorders of the peripheral nerves and muscles.

The program records more than 2,000 patient visits

annually, primarily adults age 18 and older. About two-

thirds of our patients are over the age of 50.

Our advanced neurodiagnostic facilities include a

state-of-the-art Electromyography (EMG) Laboratory

and a Muscle and Nerve Laboratory. The EMG Lab

provides comprehensive nerve conduction studies

and EMG evaluations performed by expert staff.

Because electrodiagnostic evaluation is an extension

of clinical findings, our medical specialists perform a

focused neuromuscular examination, including history

and physical, before conducting the electrical test. In

addition to nerve conduction and EMG, electrodiagnostic

studies available at the lab include repetitive nerve

stimulation, blink reflexes, cranial nerve studies, single-

fiber electromyography and facial/trigeminal neuropathy.

An invaluable diagnostic test, EMG provides evidence

in support of diagnoses of peripheral neuropathies;

motor neuron diseases such as amyotrophic lateral

sclerosis and spinal muscular atrophy; muscle

disorders such as myopathy and muscular dystrophy;

neuromuscular junction disorders such as myasthenia

gravis; entrapment neuropathies such as carpal tunnel

syndrome, ulnar and peroneal neuropathies; and

traumatic nerve injury, including evaluation of the

brachial plexus and facial neuropathy.

Our Muscle and Nerve Laboratory helps improve

diagnosis in cases with limited neuromuscular findings

by locating abnormalities at a pathologic/microscopic

level. Affiliated subspecialists perform muscle, nerve

and skin biopsies, which are further processed by

highly experienced staff. Our preferred technique is

open biopsy under local anesthesia, which reduces the

likelihood of missing abnormalities in cases of patchy

involvement, such as in inflammatory myopathies.

39

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The GBS/CIDP Foundation International has designated

our Neuromuscular Disorders Program as a center of

excellence for the diagnosis and treatment of Guillain-

Barré syndrome, chronic inflammatory demyelinating

polyneuropathy (CIDP) and other inflammatory

peripheral neuropathies. The designation was awarded

in recognition of the high standards maintained and

quality of patient care provided at the program, which

is one of only six such centers of excellence in the

United States.

Current research is focused on developing new

strategies to treat neuropathic disorders and enhance

nerve repair. With funding from the National Institutes

of Health and the GBS/CIDP Foundation International,

our investigators are studying the pathogenesis of

autoimmune neuropathies, immune effectors and

nerve repair, novel strategies to enhance axon

regeneration and nerve repair, and the development

of MRI technology to assess neuromuscular disorders

in preclinical and clinical studies.

41

Movement Disorders and Neurodegenerative Diseases rESEArCH HIGHLIGHt Neuromuscular Disorders

mhmni.com

priNcipal iNvestiGator: Kazim Sheikh, M.D., Professor, Department of Neurology, The University of Texas

Health Science Center at Houston (UTHealth) Medical School, and Director of the Neuromuscular Disorders Center

at Mischer Neuroscience Institute

co-iNvestiGators: Ponnada Narayana, Ph.D., M.Sc., Professor, Department of Radiology, and Director of Magnetic

Resonance Research, The University of Texas Health Science Center at Houston (UTHealth) Medical School.

Milan Sen, M.D., Assistant Professor, Department of Orthopedic Surgery, The University of Texas Health Science

Center at Houston (UTHealth) Medical School

Traumatic neuropathies form an important subgroup among peripheral disorders because they commonly affect

young adults with a higher probability of nerve regeneration and recovery, assuming optimal case management.

Despite substantial evidence of the higher regenerative capacity of injured nerves in young patients, short- and

long-term outcomes following peripheral nerve injury are unsatisfactory.

Our previous experimental work with quantitative diffusion tensor imaging (DTI) shows that the noninvasive

modality is sensitive and specific in determining nerve integrity, Wallerian-like degeneration and regenerative response.

With funding from the National Institutes of Health, our investigators are studying the feasibility and effectiveness

of DTI in imaging normal human nerves and patients with traumatic nerve injury.

0

0.2

1

0.8

0.6

0.4

0 2 4

Location (cm)

6 8 10 12 14

FA

Median Nerve Ulnar Nerve

Right Forearm Spatial Variation of FA

Non-invasive imaging to Quantify peripheral Nerve injury and repair in clinic

the DtI image in the left panel show an injured nerve; the image on the right depicts an uninjured nerve. the nerve signal can be quantified along the length of the nerve as shown in the graph.

SCOPE OF SErVICES

42

NeurorehabilitationPatients recovering from neurological illness or injury

benefit from innovative neurorehabilitative technology

and integrated care at the Mischer Neuroscience Institute

(MNI) and TIRR Memorial Hermann. Subspecialists

affiliated with both facilities are expert in the treatment of

hemorrhagic and ischemic stroke; neurological disorders

such as multiple sclerosis, Parkinson’s disease and

Guillain-Barré syndrome; traumatic brain injury; spinal

cord injury; neurodegenerative disorders; and general

neurorehabilitation.

Mischer NeurorehabilitationMemorial Hermann-Texas Medical Center’s 23-bed

inpatient neurorehabilitation unit provides comprehensive

care and an aggressive program of physical therapy,

occupational therapy and speech-language pathology.

Patients and families are an integral part of our

Neurorehabilitation Program. Upon admission, they discuss

their goals with our interdisciplinary team and together,

we develop a treatment plan designed to help them reach

their highest level of function. Mischer Neurorehabilitation

provides innovative and evidence-driven rehabilitation by

blending manual and technologic therapies, including

Korebalance™, Bioness® and IREX® Virtual Reality.

tirr Memorial hermannA national leader in medical rehabilitation and research,

TIRR Memorial Hermann is a model for interdisciplinary

rehabilitation services, patient care, education and

research. The hospital is one of only six in the nation

designated as model systems by the National Institute on

Disability and Rehabilitation Research (NIDRR) for both

its spinal cord injury and traumatic brain injury programs.

For 22 consecutive years, U.S.News & World Report

has named the hospital to its list of “America’s Best

Hospitals.” In 2011, TIRR Memorial Hermann was ranked

fourth in the nation.

Research done at the hospital is conducted by physicians

and scientists, and also by our therapists, nurses,

chaplain and the residents who rely on us to advance

their knowledge in specialized areas of rehabilitation

medicine. Our Brain Injury Research Center (BIRC) brings

together world-renowned researchers to study the many

complicated facets of recovery from brain injury, leveraging

resources from NIDRR and from the National Institutes of

Health to conduct research identifying effective treatments.

TIRR Memorial Hermann’s Physician and Specialty Clinic

is a physician-based clinic designed to meet the needs

of individuals with disabilities age 13 and older who

require initial or continuing care by a physician. The clinic

is redefining the hospital’s outpatient rehabilitation care

model by providing a patient-centered medical home

for people with disabilities. Seventeen specialty medical

clinics include brain injury, stroke, spasticity management,

neurosurgery, neurology, neuropsychology, psychiatry

and more.

TIRR Memorial Hermann Adult and Pediatric Outpatient

Rehabilitation logged more than 50,000 outpatient

therapy visits in 2010. Innovative technology in use at the

center includes Bioness equipment and the Lokomat®,

the world’s first driven-gait orthosis. We are the only facility

in Texas with pediatric legs for the Lokomat. The outpatient

center provides comprehensive physicial, occupational and

speech therapy as well as support groups, counseling and

individualized training to prepare families and caregivers

43

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for taking on the additional responsibilities of caring

for patients after inpatient discharge.

Although our patients are much higher acuity than

most rehabilitation facilities nationwide, TIRR Memorial

Hermann consistently has significant, positive functional

independence measure (FIM) change scores.

0

60

40

20

50

30

10

TIRR Nation Region

Spinal Cord Injuries Treated

Source: chart data based on calendar year 2010

Neurorehabilitation: Functional Independence Measure Change

41.3

62.257.5

79.7

Stroke All Neurological

Admit FIM Discharge FIM

Perc

ent T

raum

atic

(%)

Perc

ent T

raum

atic

(%)

0

60

40

20

50

30

10

TIRR Nation Region

Brain Injuries Treated

SCOPE OF SErVICES

44

Neurotrauma/Critical Care The Mischer Neuroscience Institute’s Neurotrauma/

Critical Care Program is internationally recognized for the

treatment of high-acuity brain and spinal cord injuries.

Our program continues to grow, with more than 1,400

patients diagnosed in 2010.

Patients with acute neurological injuries benefit from

Memorial Hermann-Texas Medical Center’s Level I Trauma

Center – one of only two in the area and the busiest in

the nation – and from Memorial Hermann Life Flight®,

the first air medical transport service established in

Texas and the second in the nation.

Accredited by the Commission on Accreditation of

Medical Transport Services, Memorial Hermann Life

Flight provides high-quality care and safe air transport

for critically ill and injured patients via helicopter and

fixed-wing aircraft. Our helicopter service responds

within a 150-mile radius of Memorial Hermann-TMC.

Fixed-wing service is available beyond 150 miles with

world operating authority. Memorial Hermann Life

Flight, the only hospital-based air ambulance service

in Houston, operates 24 hours a day, 365 days a year,

weather permitting. Since its inaugural flight, the medical

transport service has flown more than 130,000 missions.

The Mischer Neuroscience Institute houses the largest

and busiest neurointensive care unit of its kind in

the region. Neurointensivists and experienced mid-level

practitioners staff our dedicated Neuro ICU around

the clock to provide ongoing intensive care to critically

ill patients.

We are an international leader in research conducted on

innovative treatments following neurotrauma, including

participation in several multicenter trials. Investigators

at MNI and TIRR Memorial Hermann are studying

biomarkers for pain in spinal cord injury, cranioplasty

outcome following decompressive craniectomy, the

effects of erythropoietin on cerebrovascular dysfunction

and anemia in traumatic brain injury (TBI), neural and

behavioral sequelae of blast-related TBI, progesterone for

the treatment of TBI, the safety and pharmacokinetics of

riluzole in patients with traumatic acute spinal cord injury

and other basic science research and clinical trials.

Neurotrauma Program Growth

0

400

1200

800

200

1000

600

14001600

20082007 2009 2010

Number Diagnosed

Our Neurotrauma Program continues to grow. In

calendar year 2010, more than 1,400 patients with

acute neurological injuries benefited from Memorial

Hermann-texas Medical Center’s Level I trauma

Center and care provided at the Mischer Neuroscience

Institute.

45

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46

SCOPE OF SErVICES

Spine The highly skilled spine surgeons at the Mischer

Neuroscience Institute are known for their expertise

and innovative treatment options for patients with back

pain resulting from trauma, degenerative disc disease,

osteoporosis and related stress fractures, and deformity,

including kyphosis and scoliosis.

We perform more than 1,000 surgeries each year in

new, state-of-the-art facilities equipped with advanced

instruments and dynamic imaging systems. Our clinicians

provide exceptional care for patients with traumatic spine

injury, including the 10 to 20 percent of admissions

through our Level I Trauma Center that involve

neurological damage. Based on benchmark University

HealthSystem Consortium data, the Spine Center’s

inpatient mortality for spine trauma, degenerative spine

disease and elective spine surgery has been consistently

lower than expected for the past four years.

We are skilled at innovative procedures for the relief

of neck and back pain, including minimally invasive

approaches. Specialties include lumbar fusion, lumbar

microdiscectomy, anterior cervical spine fusion,

scoliosis surgery, spine osteotomies, kyphoplasty,

thermal nucleoplasty, micro-endoscopic discectomy,

transforaminal lumbar interbody fusion (TLIF) and disc

replacement surgery.

Research under way at the MNI Spine Center is focused

on bringing promising therapies for spinal cord injury

(SCI) patients from the laboratory to clinical trials in

a manner that will provide evidence of effectiveness,

with maximum safety, to patients undergoing treatment.

Investigators are currently evaluating the safety and

preliminary efficacy of the anticonvulsant drug riluzole

in patients with acute SCI.

47

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Spinal Tumor: Length of Stay

0

6

2

10

4

8

1412

20092008 2010 20110

100

160

8060

140

40

120

20



Actual Expected

Actual Expected

Actual Expected


Volu

me

Spinal Tumor: Inpatient Mortality

02

64

8

141210

20092008 2010 2011

Spine Trauma: Length of Stay

9.5

11

10

12.5

10.5

11.5

13

12

20092008 2010 20110

1000

1200

800

600

400

200

Volu

me

Spine Trauma: Inpatient Mortality

01

32

4

8765

20092008 2010 2011

Spine Degenerative or Elective: Length of Stay

0

6

2

4

8

20092008 2010 2011400

800

600

Volu

me

Spine Degenerative or Elective: Inpatient Mortality

0

1

0.5

1.5

3

2.5

2

20092008 2010 2011

Bette

r tha

n ex

pect

edBe

tter t

han

expe

cted

Bette

r tha

n ex

pect

ed

Bette

r tha

n ex

pect

edBe

tter t

han

expe

cted

Bette

r tha

n ex

pect

ed

Source: chart data based on ICD9 codes, per fiscal year Source: chart data based on ICD9 codes, per fiscal year



QuALItY & OutCOMES MEASurES Spine

48

research & Innovation

cereBrovascular

a randomized, Double-Blind, placebo-controlled

ascending single-Dose study of the intravenous infusion

of cNto 0007 in subjects Who have experienced

ischemic cerebral infarction.

PRINCIPAL INVESTIGATOR: sean savitz, M.D.

A safety and tolerability study of a single intravenous

(IV) infusion of CNTO 0007, human stem cell product

obtained from the umbilical cord of a single healthy donor,

compared with placebo when administered subacutely

following an ischemic stroke.

a randomized Multicenter clinical trial of unruptured

Brain avMs (aruBa)

PRINCIPAL INVESTIGATOR: p. roc chen, M.D.

ARUBA is an FDA and institutional IRB approved

randomized multicenter international clinical trial designed

to determine whether medical management improves long-

term outcomes of patients with unruptured brain AVMs,

compared to interventional therapy (with endovascular

procedures, neurosurgery, or radiotherapy, alone or in

combination). This trial tests whether medical management

or interventional therapy will reduce the risk of death or

stroke (due to hemorrhage or infarction) by at least

46 percent (an absolute magnitude of about 9.5

percent over five years). A total of 400 patients will be

enrolled in order to detect the hypothesized 46 percent

reduction in event rate, analyzed using the intention-

to-treat principal. This sample size supports a test of

non-inferiority if medical management is not superior

to interventional therapy. Patients are followed for a

minimum of five years and a maximum of 10 years

from randomization.

albumin in acute stroke trial – alias: a phase iii

randomized Multicenter clinical trial of high-Dose

human albumin therapy for Neuroprotection in

acute ischemic stroke

PRINCIPAL INVESTIGATOR: elizabeth Jones, M.D.

An efficacy study to determine whether IV high-dose

albumin reduces stroke severity compared to standard

care (with or without tPA) in patients within five hours of

stroke onset. This study is the first to be organized and

run by Emergency Physicians, and is the final pivotal

step in determining if albumin is an effective stroke

treatment.

Physicians at the Mischer Neuroscience Institute and The University of Texas Health Science Center at Houston (UTHealth)

Medical School are engaged in a broad and intensive research program focused on the mechanisms, treatment and cure of

neurological disease and injury. We use diverse approaches – molecular, transgenic and electrophysiological techniques – in

biomedical studies, translational research, clinical trials and technology development and assessment.

Our projects are supported by the National Institutes of Health, the Vivian L. Smith Foundation for Neurologic Disease, the

American Stroke Association and other granting agencies. They cover major areas of neurological disease, including stroke,

aneurysm, spinal cord injury, brain tumor, stem cell therapies, neuroprotection, hypoxic encephalopathy, epilepsy, traumatic

brain injury and Parkinson’s disease. During the 2010 calendar year, researchers at the Institute and the UTHealth Medical

School received more than $11.7 million in 41 grants and contracts – over $7.5 million for neurology and $4.2 million for

neurosurgery. The following listing is a sample of ongoing or recently completed research projects.

49

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50

assessment of spleen size reduction and inflammatory

Markers in acute stroke over time (assist)

PRINCIPAL INVESTIGATOR: preeti sahota, M.D.

An observational study to evaluate the changes in spleen

size and blood flow over time using ultrasound and

corresponding changes in inflammatory cytokines in acute

stroke patients presenting within six hours of symptom

onset. The results of the study may provide insight into

potential future therapies for acute stroke targeting the

immune processes in the spleen.

Blood-Brain Barrier permeability changes as

a predictor of complications in tpa-treated patients

PRINCIPAL INVESTIGATOR: tzu-ching Wu, M.D.

Hemorrhagic transformation and cerebral edema can be

devastating complications of stroke. This retrospective study

is investigating the relationship between permeability of the

blood-brain barrier and stroke complications.

Bugher Foundation center for stroke prevention

PRINCIPAL INVESTIGATOR: Dong h. Kim, M.D.

This project is focused on identifying gene mutations

associated with cerebral aneurysm formation and

understanding molecular mechanisms that lead to

the disease.

carotid revascularization endarterectomy versus

stenting trial (crest)

PRINCIPAL INVESTIGATOR: Nicole Gonzales, M.D.

In an effort to find better ways to prevent strokes in

people with carotid stenosis, this national, multi-center

research study is comparing carotid endarterectomy to the

study procedure, carotid artery stenting. Researchers are

evaluating the relative effectiveness of both treatments in

preventing stroke, myocardial infarction and death in the

30-day period immediately following the procedure.

clinical outcome and patient Factors in refusal to

intravenous tissue plasminogen activator therapy for

Management of acute ischemic stroke – perspectives

from a comprehensive stroke treatment

PRINCIPAL INVESTIGATOR: Farhaan s. vahidy, ph.D.

This is a retrospective chart review study to compare the

clinical outcome in patients who are eligible to receive tPA

treatment, yet refuse it, as compared to patients who received

the treatment. In addition, researchers are seeking to highlight

some predictors in patient characteristics for tPA refusal.

clotBust-hF combined lysis of thrombus in Brain

ischemia with transcranial ultrasound and systemic

tpa-hands-Free: a phase i/ii pilot safety trial

PRINCIPAL INVESTIGATOR: andrew Barreto, M.D.

The safety of a novel, external hands-free transcranial

Doppler ultrasound system is being tested in two study

groups: healthy subjects and people with ischemic stroke.

r E S E A r C H

51

combination treatment of rtpa and apyrase

for stroke

PRINCIPAL INVESTIGATOR: Jaroslaw aronowski, ph.D.

This pre-clinical study is designed to evaluate the role

of apyrase, an endogenous vascular ATPase, as a

mechanism to prevent thrombosis after ischemic stroke

when used in combination with rtPA.

combination therapy of aspirin and apyrase

for stroke


This pre-clinical proposal is designed to evaluate the

role of apyrase, an endogenous vascular ATPase, in

combination with aspirin to prevent thrombosis after

ischemic stroke.

Dias 4 – Desmoteplase in acute stroke

PRINCIPAL INVESTIGATOR: George lopez, M.D., ph.D.

An efficacy study to determine whether the potent IV

clot busting drug desmoteplase improves outcome in

patients who arrive too late for IV tPA but within nine

hours of stroke onset. Desmoteplase is derived from

vampire bat saliva and previous studies suggest benefit

in patients with normal CT scans and persisting arterial

occlusion beyond three hours.

Defining Genetic and environmental Modifiers

of vascular Disease

PRINCIPAL INVESTIGATOR: hariyadarshi pannu, ph.D.

This research focuses on defining molecular differences

between vascular beds, the role these differences play in

conferring differential susceptibility to vascular diseases

and the identification of factors that lead to variable

gender-specific vascular disease susceptibility.

ethnic/racial variation in intracerebral

hemorrhage (erich)


A genetic study aimed at determining the significant

medical, environmental, and genetic risk factors and

causes of stroke and how they may vary by race and

ethnicity. Genes influencing blood pressure, blood vessel

walls, clotting and other factors may increase the risk of

developing a hemorrhagic stroke. New treatments that

affect these factors may be developed to prevent stroke.

evaluation of presidio and cerecyte coils

in large and Giant aneurysms

PRINCIPAL INVESTIGATOR: p. roc chen, M.D.

A multi-site registry designed to assess the angiographic

outcomes and morbidity/mortality of endovascular

treatment of large and giant aneurysms using at least one

Presidio™ framing coil in conjunction with other Cerecyte®

coils. Data is collected on immediate and 12-month

post-treatment angiographic occlusion rates, morbidity

and mortality rates, retreatment rates, packing density

and recurrence rates. This study is principled by Micrus

Endovascular Corporation, out of San Jose, California.

Genetic analysis of cerebral aneurysms

PRINCIPAL INVESTIGATOR: teresa santiago-sim, ph.D.

Researchers are identifying genetic alterations that

predispose individuals to cerebral aneurysms as well as

potential cerebral aneurysm biomarkers that can aid in

the diagnosis of individuals at an increased risk of

developing the disease.

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52

influence of changes in corticospinal tract integrity

over time on clinical outcome in acute ischemic

stroke (ict-ais)


This is a prospective pilot study to evaluate the influences

of changes in corticospinal tract integrity over time on motor

and cognitive outcomes in patients with acute ischemic

stroke in the middle cerebral artery territory within 48 hours

of stroke onset. Patients will undergo detailed cognitive and

fine-motor testing as well as advanced neuroimaging.

intra-arterial treatment (iat) in patients with

unknown stroke onset time

PRINCIPAL INVESTIGATOR: ramy el Khoury, M.D.

Patients who wake up with stroke symptoms or patients

with unknown stroke symptom onset time are typically

outside the conventional three-hour window for intravenous

tPA. This is a retrospective study looking at safety of IAT in

patients presenting with unknown stroke onset times.

is the Drip-and-ship approach to Delivering

intra-arterial therapy after iv tpa safe for acute

ischemic stroke?


Intra-arterial therapy is an investigational therapy for

stroke. We are looking at the safety of treating patients

at outside facilities with intravenous tPA and then

transferring them for clot removal via intra-arterial

procedures at our institution.

Minimally invasive surgery plus tpa for intracerebral

hemorrhage evacuation (Mistie)

PRINCIPAL INVESTIGATOR: George lopez, M.D.

This study was designed to produce data regarding

the capability of minimally invasive surgery with

recombinant tissue plasminogen activator (rt-PA) to

remove blood clots from intra-cerebral hemorrhage

patients.

r E S E A r C H

53

Mr and recanalization of stroke clots using

embolectomy (Mr rescue)

PRINCIPAL INVESTIGATOR: James Grotta, M.D.

A comparison of intra-arterial (IA) catheter-based

mechanical clot removal to standard care in patients up

to eight hours after stroke onset who are ineligible for

or have failed treatment with IV tPA. This study is testing

whether we can use an MRI in order to select patients

who may benefit in this extended time window.

Neurofluctuations in patients with

subcortical ischemic stroke (Niss)


The purpose of this prospective observational study is to

capture and report the incidence of neurological exam

fluctuations and their outcome in subcortical (lacunar) stroke

patients receiving standard care. The results may be used to

evaluate the results of new treatments for this disorder.

Neuroimaging of cerebrovascular Function

PRINCIPAL INVESTIGATOR: timothy ellmore, ph.D.

Researchers are studying the use of high-resolution

structural and functional neuroimaging to measure

aspects of brain anatomy and function in humans at risk

for cerebrovascular disease. The team is also studying

patients who have had hemorrhagic strokes in order to

assess the extent of damage, impact on cognitive function,

and risk for additional cerebrovascular incidents.

phase 2/3 study of intravenous thrombolysis and

hypothermia for acute treatment in ischemic stroke.

the intravascular cooling in the treatment of stroke

2/3 (ictus 2/3) trial


Brain cooling has been shown to decrease brain

swelling and reduce loss of neurologic function after

an acute stroke. It has also been proven to be highly

effective in saving lives and preventing neurological

damage after cardiac arrest and after oxygen deprivation

in newborns. This trial will look specifically at whether

hypothermia can be used safely in elderly stroke patients.

pleiotropic transcription Factors as a target for

intracerebral hemorrhage treatment


Researchers are evaluating the role of transcription

factor Nrf2 in regulating cytoprotection, antioxidative

defense and detoxification of brains injured by

intracerebral hemorrhage.

prospective analysis of the use of thrombelastography

(teG) in prediction of hemorrhage in stroke patients


This is an observational study to evaluate the use

of thrombelastography (TEG) analysis to assess the

coagulation status of patients with acute stroke presenting

within three hours of symptom onset. The purpose of

the study is to evaluate the efficacy of TEG as means

of identifying those ischemic and hemorrhagic stroke

patients at increased risk of bleeding.

relation of coagulability and iodine exposure to

outcome of patients with ischemic strokes treated

with intra-arterial therapy


Coagulation disorders and excess iodine exposure

could worsen patient outcome. We are studying the

relation between these two factors in patients treated

with intra-arterial therapy.

mhmni.com

54

retrospective comparison of pediatric stroke

patients treated With or Without intravenous tpa

and Descriptive analysis


More commonly than previously thought, children can

have strokes. We are aiming to describe our single-center

experience in treating pediatric patients with intravenous tPA.

safety/Feasibility of autologous Mononuclear Bone

Marrow cell treatment for acute ischemic stroke


Cell-based therapy has emerged as a novel investigational

approach to enhance recovery after ischemic stroke.

Numerous studies have shown that the administration of

cells is safe and improves outcome in animal models.

Our researchers will enroll 30 patients who have suffered

an ischemic stroke in a safety study of an IV infusion of the

patient’s own cells within 24 to 72 hours after the onset

of symptoms.

safety of autologous Bone Marrow cell treatment

for acute ischemic stroke trial – reasons for

poor enrollment


This retrospective study is to assess and understand

the reasons for poor patient enrollment in the Safety of

Autologous Bone Marrow Cell Treatment for Acute Ischemic

Stroke Trial. The study is closed and in the data analysis

stage seeking to better understand why people are

reluctant to enroll in research trials.

safety of intravenous thrombolysis for Wake-up stroke


This is a safety study of acute treatment with IV tPA in

ischemic stroke patients who wake up with their stroke

symptoms. The administration of tPA must occur within

three hours of awakening from sleep. The primary aim

of this study is to demonstrate the safety of IV tPA in

ischemic stroke patients who present to the emergency

department after awakening.

safety of pioglitazone for hematoma resolution

in intracerebral hemorrhage (shriNc) and Mri

evaluation of hematoma resolution as a surrogate

Marker of clinical outcome in intracerebral

hemorrhage


This study compares the safety of pioglitazone with

standard of care for patients with spontaneous cerebral

hemorrhage. The drug is administered in increasing

doses from 0.1 to 2 mg/kg/d for three days, followed

by a lower maintenance dose, within 24 hours of the

start of symptoms.

spotrias project 2: a pilot study to Determine

the safety of argatroban injection in combination

with rtpa in patients with acute ischemic stroke


This clinical trial is assessing the safety of combining the

anticoagulant argatroban and recombinant tPA to treat

patients who have had acute ischemic stroke.

stem cells in stroke patients (steM)


This is a safety study of bone marrow cell harvest and

IV administration of the patient’s own mononuclear stem

cells in patients within 72 hours of stroke onset. This is

the first human study of stem cells in stroke patients,

the only one in Houston, and an approach that reduces

injury and promotes recovery in animal models.

r E S E A r C H

55

surgical treatment Modalities for intracerebral

hemorrhage (ich) Management


Intracerebral hemorrhage represents about 15 percent

of all strokes. We are comparing outcomes for two

different surgical techniques -- hemicraniotomy and

hemicraniectomy – in cerebral hemorrhage patients.

the interventional Management of stroke trial – iMs iii


An efficacy study adding an intra-arterial (IA) catheter-

based mechanical clot removal to IV tPA compared to

standard IV tPA treatment alone in patients within three

hours of stroke onset. This is the final pivotal step in

determining if the combined IV + IA approach is effective

in improving clinical outcome.

the Weekend effect on intra-arterial therapy


Intra-arterial therapy for acute stroke is an emergency

procedure. Previous cardiac studies showed a possible

‘weekend effect’ where patients treated on the weekend

have worse outcomes. We are studying whether the

‘weekend effect’ exists for intra-arterial therapy in

comprehensive stroke centers.

to retrospectively study predictors of outcome in

sub-acute ischemic stroke in Middle cerebral artery

(Mca) territory During hospitalization


The purpose of this retrospective study is to identify

the predictors of outcome in patients with ischemic

stroke in middle cerebral artery (MCA) territory during

the sub-acute stage (day two to day seven, or discharge

time, whichever is earlier), irrespective of whether they

undergo thrombolytic or interventional therapies during

the acute stage (day one). The rationale behind this study

is that the outcome during the sub-acute phase is likely

to have a bearing on the kind of patients we select for our

interventional clinical trials during this period, such as

stem cell therapy.

treatment of central retinal artery occlusion

with intra-arterial thrombolysis


Central retinal artery occlusion can cause complete

vision loss. We are looking at outcomes of patients treated

with endovascular therapy.

utilization of intensive care resources in severe

intracranial hemorrhage


Researchers are identifying all patients with intracranial

hemorrhage treated by the Mischer Neuroscience Institute

stroke team from 2004 to January 2009. This review of

medical charts is capturing information that predicts whether

patients should receive prolonged care or hospice care.

mhmni.com

56

epilepsY

a Multicenter, open-label extension trial to assess the

long-term use of lacosamide Monotherapy and safety

of lacosamide Monotherapy and adjunctive therapy in

subjects with partial-onset seizures

PRINCIPAL INVESTIGATOR: Jeremy slater, M.D.

This study is demonstrating the effectiveness and safety of

administering lacosamide, an investigational anticonvulsant,

to patients with partial-onset seizures who are withdrawn

from one to two established antiepileptic drugs.

correlation of Waking Background alpha Frequency with

Measures of attention and reaction


Researchers are studying alpha brainwave frequency and

its relationship to varying levels of alertness.

Diffusion imaging for seizure Focus localization


This project is evaluating the feasibility of using diffusion-

weighted MRI (DW-MRI) to localize the seizure onset zone

in epilepsy patients.

initial treatment of status epilepticus (itse):

a preliminary study for First: comparison of

Fosphenytoin and levetiracetam

PRINCIPAL INVESTIGATOR: omotola hope, M.D.

This retrospective review of charts is being undertaken

in preparation of a pilot study comparing two drugs,

fosphenytoin and levetiracetam, for the control of status

epilepticus unresponsive to lorazepam.

lateralizing Memory Function in epilepsy patients

with oxygen-enhanced fMri


This ongoing study is evaluating the effectiveness of

oxygen-enhanced functional magnetic resonance imaging

for increasing memory task-related blood oxygen level-

dependent signals in the hippocampus and neocortex of

epilepsy patients and control subjects.

oxygen-enhanced Magnetic resonance imaging

in Non-lesional Focal epilepsy

PRINCIPAL INVESTIGATOR: Giridhar Kalamangalam, M.D., D.phil.

This ongoing study is evaluating how effective oxygen-

enhanced MRI scans are at identifying subtle brain

lesions in patients with refractory focal epilepsy.

Quantitative analysis of electroencephalogram

in epilepsy

PRINCIPAL INVESTIGATOR: Giridhar Kalamangalam, M.D., D.phil.

By analyzing EEG and video-EEG data already collected

for clinical purposes, this study seeks new ways of

understanding brain function in normal subjects and in

people with neurological problems such as seizures.

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57

sp902: a historical-controlled, Multicenter,

Double-Blind, randomized trial to assess the

efficacy and safety of conversion to lacosamide

400mg/day Monotherapy in subjects with

partial-onset seizures


Lacosamide is an investigational anticonvulsant drug.

This study is demonstrating the effectiveness and safety

of administering lacosamide to patients with partial-

onset seizures who are withdrawn from one to two

established antiepileptic drugs.

Multiple sclerosis

a Multicenter, Double-Blind, randomized study

comparing the combined use of interferon Beta-

1a and Glatiramer acetate to either agent alone in

patients with relapsing-remitting Multiple sclerosis

PRINCIPAL INVESTIGATOR: John William lindsey, M.D.

This Phase III study is investigating whether combined

treatment with the drugs interferon beta-1a intramuscular

given once weekly and glatiramer acetate subcutaneous

given daily is more effective than either drug alone in

treating relapsing-remitting multiple sclerosis.

acorda protocol Ms F203: Double-Blind, placebo-

controlled, 21-week, parallel-Group study to evaluate

the safety and efficacy of oral Fampridine-sr (10 mg

BiD) in subjects with Multiple sclerosis and acorda

F203 extension: an open label extension study to

evaluate the safety, tolerability and activity of oral

Fampridine-sr in subjects with Multiple sclerosis

who participated in the Ms f203 trial.


In this placebo-controlled study, researchers are

assessing the safety and efficacy of fampridine-SR

in patients diagnosed with multiple sclerosis.

mhmni.com

automated Mr image analysis in Ms:

identification of a surrogate

PRINCIPAL INVESTIGATOR: ponnada a. Narayana, ph.D.

Researchers are developing a general, PC-based

automated image analysis system and applying it to

determine those MRI metrics that best predict near-term

clinical change in multiple sclerosis.

combination therapy in Multiple sclerosis

PRINCIPAL INVESTIGATOR: Jerry Wolinsky, M.D.

This study is determining if the combination of interferon

beta-1a and glatiramer acetate is superior to either drug

as monotherapy in relapsing-remitting multiple sclerosis.

Detection of Ms-related cognitive impairment:

in search of Mri surrogate Markers

PRINCIPAL INVESTIGATOR: Flavia Nelson, M.D.

This study is the first to use fMRI, DTI and other advanced

imaging techniques to evaluate the effect of cortical

lesions and white matter tract damage on cognitive

function in multiple sclerosis patients.

Double-Blind, placebo-controlled, 20-Week, parallel-

Group study to evaluate safety, tolerability and activity

of oral Fampridine-sr in subjects with Multiple

sclerosis and open label extension study to evaluate

safety, tolerability and activity of oral Fampridine-sr in

subjects with Multiple sclerosis


Researchers are investigating the safety and efficacy of

three dose levels of fampridine-SR – 20 mg, 30 mg and

40 mg – in patients diagnosed with multiple sclerosis.

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epstein-Barr virus and Multiple sclerosis:

correlation of activity


Epstein-Barr virus is a common infection linked to MS, but

it is not known if the virus actually causes the disease. This

study will investigate the correlation between reactivation of

Epstein-Barr virus and disease activity in multiple sclerosis.

The results of this will be important in determining whether

this virus may be the cause of multiple sclerosis.

evaluation of oral administration of acth

(corticotrophin) in Normal volunteers – a pilot study

PRINCIPAL INVESTIGATOR: staley Brod, M.D.

This study was designed as a prospective cohort study

to determine whether oral administration of ACTH has

immunological and endocrinological effects.

Mri analysis center for protocol eFc6058 -

a Multi-center Double-Blind parallel-Group placebo-

controlled study of the efficacy and safety of

teriflunomide in patients with relapsing Multiple

sclerosis Who are treated with interferon-Beta.


This study provides quantitative image analysis measures

as supportive outcome measures.

Mri analysis center for protocol eFc6260 – an

international, Multi-center, randomized, Double-Blind,

placebo-controlled, parallel Group study to evaluate the

efficacy and safety of two-Year treatment with 7 mg once

Daily and 14 mg once Daily versus placebo in patients With

a First clinical episode suggestive of Multiple sclerosis


This pivotal clinical trial provides quantitative image

analysis measures as supportive outcome measures.

Mri analysis center for protocol lts6050 -- a long-

term extension of the Multinational, Double-Blind,

placebo controlled study eFc6049 (hMr1726Dl3001)

to Document the safety of two Doses of teriflunomide

(7 and 14 mg) in patients with Multiple sclerosis

with relapses


This study provides quantitative image analysis measures

as supportive outcome measures.

National Multiple sclerosis society (NMss):

chronic cerebrospinal venous insufficiency and

its relationship to Ms


This NMSS-funded study is an ongoing interdisciplinary project

to determine if punitive alterations in cerebral venous outflow

can be reliably measured and if any abnormalities can be

specifically associated with multiple sclerosis.

open label study to evaluate the safety of copaxone®

and to Monitor the Neurologic course of the Disease

in Multiple sclerosis patients treated with copaxone


Researchers are seeking to better understand the long-term

efficacy and side effects of the drug Copaxone (glatiramer

acetate) therapy in multiple sclerosis patients.

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serial Magnetic resonance spectroscopy in

Multiple sclerosis


Researchers are using serial magnetic resonance imaging

(MRI) and magnetic resonance spectroscopy (MRS) to

gather data to better understand disease processes in

patients with multiple sclerosis.

MoveMeNt DisorDers aND

NeuroDeGeNerative Diseases

a Natural history of rapid eye Movement (reM) sleep

Behavior Disorder as prognostic for parkinson’s Disease

PRINCIPAL INVESTIGATOR: Mya schiess, M.D.

Researchers are validating a combination of biological

and clinical markers in people with REM sleep behavior

disorder as an indicator of the state of idiopathic

Parkinson’s disease before symptoms appear.

amyloid-beta oligomers and alzheimer’s Diagnosis

PRINCIPAL INVESTIGATOR: claudio soto, ph.D.

The major goal of this project is to adapt the protein

misfolding cyclic amplification (PMCA) technology for

the specific and highly sensitive detection of misfolded

Aβ oligomers in human biological fluids. Investigators

are optimizing the experimental conditions of cyclic

amplification of Aβ misfolding, identifying Aβ misfolded

oligomers in AD biological fluids, and evaluating the

sensitivity and specificity and the earliest time during the

pre-symptomatic phase in which Aβ oligomers can be

detected in biological fluids.

cross-sectional cohort study of laboratory and clinical

patterns in early parkinson’s Disease

PRINCIPAL INVESTIGATOR: Mya schiess, M.D.

This study is designed to characterize and define

serum and cerebrospinal fluid values for inflammatory

cytokines and early idiopathic Parkinson’s disease (IPD).

Researchers are also looking for patterns in early IPD,

hoping that they may lead to early diagnosis before

symptoms occur.

cyclic amplification of prion protein Misfolding


The major goals of this project are to understand the

mechanism of prion replication and the nature of the

infectious agent, and to develop novel strategies for

diagnosis of prion diseases.

Neurodegeneration in prion Diseases


This study is investigating the mechanism of brain

degeneration in prion diseases and, in particular, the role

of the endoplasmic reticulum chaperone protein Grp58.

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pathogenesis, transmission and Detection of

Zoonotic prion Diseases


Researchers are studying the pathogenesis and routes

of propagation of bovine spongiform encephalopathy

and chronic wasting disease, and developing novel

strategies for the detection of infected animals.

pathogenic Mechanism of prion Disease


This Program Project grant involves several groups.

Our major goal is to understand the molecular basis

of human prion replication and to develop novel strategies

for diagnosis.

peripheral and central protein Biomarkers of Brain Mr

activity in Demyelinating Disease

PRINCIPAL INVESTIGATOR: staley Brod, M.D.

By studying patients with new or disappearing brain

lesions, it may be possible to identify protein markers that

repair damage to the brain and can be used as future

therapies. This sub-study is investigating whether specific

proteins in the blood and spinal fluid change in the

presence of new brain lesions.

small-Molecule Beta-sheet Breaker peptidemimetics

for alzheimer’s therapy


This project seeks to identify small chemical molecules

mimicking the structure and activity of β-sheet breaker

peptides previously demonstrated to be active in

inhibiting and disassembling amyloid fibrils.

NeuroMuscular DisorDers

Baxter-pNs 2010-2011 Fellowship award

PRINCIPAL INVESTIGATOR: Kazim sheikh, M.D.

The purpose of this project is to evaluate whether

neuron-specific inhibition of RhoA leads to enhanced

regeneration and repair in injured nerves.

Biologic effects of anti-Ganglioside antibodies


Examine the biologic effects of anti-ganglioside

antibodies on nerve regeneration.

GBs/ciDp Foundation Grant


Researchers are engineering chimeric proteins to

enhance nerve repair in antibody-mediated preclinical

models of autoimmune neuropathy.

Neuroprotection and enhancement of Nerve

repair with erythropoietin (epo) in experimental

allergic Neuritis (eaN)


The purpose of this study is to examine the

neuroprotective properties of EPO in EAN.

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Noninvasive imaging to Quantify peripheral

Nerve injury and repair in clinic


Researchers are studying diffusion tensor imaging to

assess and quantify nerve degeneration and regeneration

in patients with traumatic nerve injuries.

pathogenesis of anti-Ganglioside

anti-Mediated Neuropathies


Researchers are evaluating the role of pathogenic

mechanisms of anti-ganglioside antibodies in

autoimmune neuropathy.

phenotype Differences in Motor and sensory

Neuron regeneration in inbred Mice


This study is determining the genetic drivers of phenotypic

differences in nerve regeneration in inbred mice.

Neuro-oNcoloGY

identification of New Markers and therapeutic

targets in Glioblastoma Multiforme (GBM)

PRINCIPAL INVESTIGATOR: Min li, ph.D.

This study is to identify new markers for diagnosis and

novel therapeutic targets for molecular-targeted therapy

in GBM using genetic and molecular approaches.

NeurorehaBiliatioN

Deep venous thrombosis in post-stroke hemiplegia:

associated risk Factors placing patients at risk

PRINCIPAL INVESTIGATOR: Nneka ifejika-Jones, M.D.

Researchers are gathering preliminary data on acute

stroke patients who have developed a deep venous

thrombosis (DVT) during hospitalization for inpatient

neurorehabilitation, despite having received preventive

medication.

Functional Brain reorganization in stroke recovery

PRINCIPAL INVESTIGATOR: andrew papanicolaou, M.D.

Investigators are using MEG to assess how the brain

reorganizes itself during spontaneous recovery from stroke.

They are also studying the effects of constraint induced

therapy in the recovery process of language, sensory and

movement functions.

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improving ambulation post-stroke with robotic training

PRINICPAL INVESTIGATOR: elizabeth Noser, M.D.

The goal of this research is to look at a new rehabilitation

technique for people who have suffered a stroke causing

difficulty walking. The present study is a research study

designed to compare robotic-assisted rehabilitation therapy

using the Lokomat® with standard physician therapy to

improve walking after stroke.

NeurotrauMa/critical care

Biomarkers for pain in spinal cord injury

PRINCIPAL INVESTIGATOR: Gigi hergenroeder, r.N.

Investigators in this clinical trial believe that spinal cord

injury (SCI) patients who develop chronic pain have

biomarkers in their blood that can predict their condition.

Acute patients, and patients two or more years post-injury,

who have been identified as having neuropathic pain or

no pain, will be asked to donate blood samples that will

be evaluated for biomarkers. The ultimate goal of the

research is early intervention to prevent the onset of

chronic pain.

combinatory strategies to Functional remyelination

after spinal cord injury

PRINCIPAL INVESTIGATOR: Qilin cao, ph.D.

Researchers are identifying optimal strategies to

genetically modify oligodendrocyte precursor cells prior to

transportation to promote remyelination and functional

recovery after spinal cord injury.

North american clinical trials Network

for the treatment of spinal cord injury:

spinal cord injury registry

PRINCIPAL INVESTIGATOR: Michele Johnson, M.D.

Researchers hope to bring promising therapies for

spinal cord injury (SCI) patients from the laboratory

to clinical trials in a manner that will provide evidence

of effectiveness, with maximum safety, to patients

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undergoing treatment. This is an observational study

charting the natural course of SCI.

Norepinephrine and tBi-associated

prefrontal Dysfunction

PRINCIPAL INVESTIGATOR: Nobuhide Kobori, M.D.

The overall goal of the project is to identify the

biochemical and cellular mechanisms underlying

cognitive function deficits due to traumatic brain

injury. The NIH grant is particularly focused on the

investigation of the dysregulated neurotransmitter

signaling (norepinephrine and serotonin) in the

prefrontal cortex.

Novel Neuroprotection therapeutic approaches

for spinal cord injury (sci)


The goal of this grant is to study the molecular mechanism

to regulate the blood-brain barrier of the normal adult

central nervous system after SCI, and to identify new

therapeutic targets for SCI and other neurological

diseases by protecting the blood-brain barrier.

Novel restorative therapy for spinal injury


This study is examining the therapeutic potential of

ApoE peptides for spinal cord injury.

project 2-effects of erythropoietin on anemia and

Need for transfusion (a component of the program

project “vascular Mechanisms of secondary injury

after traumatic Brain injury (tBi)”)

PRINCIPAL INVESTIGATOR: imoigele aisiku, M.D.

This study examines the effects of TBI on cerebral blood

flow (CBF) and the effect of erythropoietin in CBF.

safety and pharmacokinetics of riluzole in

patients with traumatic acute spinal cord injury

PRINCIPAL INVESTIGATOR: Michele Johnson, M.D.

The purpose of this study is to develop acute care

safety and pharmacokinetic profiles of riluzole in patients

who have sustained a traumatic spinal cord injury.

Researchers are also conducting exploratory analyses of

functional outcomes for purposes of planning a subsequent

Phase II b – Phase III randomized study of the efficiency

of riluzole for the treatment of acute spinal cord injury.

other

a cross-model synthetic approach to

eloquent cortical regions

PRINCIPAL INVESTIGATOR: Nitin tandon, M.D.

The purpose of this study is to understand the mechanisms

of language production through an integrated application

of functional MRI, diffusion tensor imaging tractography

and intra-cranial electrophysiology.

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Brain Mapping with MeG

PRINCIPAL INVESTIGATOR: andrew papanicolaou, M.D.

This study is using noninvasive MEG imaging to compare

the structure and function of the nervous system of

subjects who have developed normally and people with

learning disabilities or neurological diseases such as

epilepsy, stroke, autism and other disorders.

chart review of patients Who underwent craniotomies

for tumor resection and epilepsy surgery


This retrospective review of patients who have undergone

craniotomies will be used to create a database of patients

who have previously undergone surgery by the principal

investigator for central nervous system tumors or epilepsy.

clinical interventions to increase organ procurement,

Nutritional status and enteral absorption capability

after Brain Death

PRINCIPAL INVESTIGATOR: Gigi hergenroeder, r.N.

This study is gathering preliminary data evaluating the

effect on donor organ outcome of enteral feeding with

immunomodulating nutrition containing omega-3 and

omega-6 fatty acids, antioxidants and glutamine.

comparative analysis of structural and Functional

characteristics of language regions as Measured by

Functional imaging and invasive electrophysiology


Researchers are working to accurately locate regions

of the brain involved in the making of language.

Functional MRI (fMRI) will be used to detect activity

in various regions of the brain during tasks performed

by patients with brain tumors or epilepsy, as well

as normal subjects. The second part of the study

is focused on patients being evaluated for epilepsy

surgery. As part of the evaluation, they will undergo

electrical brain stimulation using the same safety

guidelines as used in standard medical care, to closely

study the areas of the brain involved in language,

movement and vision.

Fronto-Basal-Ganglia circuits for selective

stopping and Braking


This project uses intra-cranial brain recordings and fMRI

to understand the dynamics of the brain substrates

involved in cognitive control.

hemicraniectomies for Malignant Middle cerebral

artery syndrome—variability in surgical technique and

prognosticating Factors

PRINCIPAL INVESTIGATOR: tzu-ching Wu, M.D.

This retrospective study is to review hemicraniectomies

performed for malignant middle cerebral artery syndrome

and grade the adequacy of the decompression based

on predefined radiological aspects. The study assessed

whether there is indeed variability in hemicraniectomy/

decompression techniques and it compared clinical

outcomes in two groups: optimal vs. suboptimal

decompression.

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Nano-engineered, Multi-channel scaffolds for

axon regeneration


Researchers are identifying the optimal nano-scaffolds

for axonal growth in vitro.

Neuroprotection against hypoxic/ischemic injury

and other Neurological Disorders

PRINCIPAL INVESTIGATOR: Ying Xia, M.D.

This NIH-funded study is investigating brain protection

against ischemia, hypoxic dysfunction and epileptic

hyper-excitability, and exploring the effects of acupuncture

on neurological disorders.

Neuroscience research repository (Nrr)

PRINCIPAL INVESTIGATOR: Dong h. Kim, M.D.

The NRR is a prospective database and tissue sample

bank that will improve knowledge of neurological illness

and injury, and ultimately change the way patient care

is delivered. The NRR collects samples from consenting

patients for clinical, genomic and proteomic analysis.

Researchers began enrolling patients in the NRR at Memorial

Hermann-TMC in the spring of 2009.

the Neural substrates of common and proper Naming


This project uses intra-cranial brain recordings to understand

the location and interaction between the substrates involved

in fluent generation of nouns and verbs, and in their failure

to do so, called the “tip-of-tongue” phenomenon.

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Selected Publications

aroNoWsKi, JaroslaW

Britton GL, Kim H, Kee PH, Aronowski

J, Holland CK, McPherson DD, Huang

SL. In vivo therapeutic gas delivery

for neuroprotection with echogenic

liposomes. Circulation. 19 Oct 2010;

122(16):1578-87. [E-pub 4 Oct 2010]

Sharma S, Yang B, Strong R, Xi X,

Brenneman M, Grotta JC, Aronowski J,

Savitz SI. Bone marrow mononuclear

cells protect neurons and modulate

microglia in cell culture models

of ischemic stroke. Journal of

Neuroscience Research Oct 2010;

88(13):2869-76.

Zhao X, Strong R, Piriyawat P,

Palusinski R, Grotta JC, Aronowski

J. Caffeinol at the receptor level:

anti-ischemic effect of N-methyl-

D-aspartate receptor blockade is

potentiated by caffeine. Stroke

Feb 2010; 41(2):363-7. [E-pub 31

Dec 2009]

Barreto, aNDreW

Martin-Schild S, Albright KC, Hallevi

H, Barreto AD, Philip M, Misra V,

Grotta JC, Savitz SI. Intracerebral

hemorrhage in cocaine users. Stroke

Apr 2010; 41(4):680-4. [E-pub 25

Feb 2010]

Hallevi H, Abraham AT, Barreto AD,

Grotta JC, Savitz SI. The spot sign

in intracerebral hemorrhage: the

importance of looking for contrast

extravasation. Cerebrovascular

Disease Feb 2010; 29(3):217-20.

[E-pub 18 Dec 2009]

BroD, staleY

Brod SA, Hood ZM. 2010. Ingested

(oral) SST (somatostatin) Inhibits EAE.

Neurology 74 Suppl 2, A560.


(oral) SST (somatostatin) Suppresses

EAE. Cytokine Abstracts 52, 1-2F, p 23.


(oral) SST (somatostatin) Suppresses

EAE. Multiple Sclerosis 2010; 16:S75.

Brod SA. 2010 Ingested Type I

Interferon – State of the Art as

Treatment for Autoimmunity Part 2,

Pharmaceuticals 3 (4): 1108-1121.

cao, QiliN

Cao QL, He Q, Wang YP, Cheng XX,

Howard RM, Zhang YP, DeVries WH,

Shields CB, Magnuson DSK, Xu

XM, Kim DH and Whittemore SR.

Transplantation of CNTF-expressing

adult oligodendrocyte precursor

cells promotes remyelination and

functional recovery after spinal cord

injury. Journal of Neurosciences 2010;

30: 2989-3001.

Cai J, Zhu Q, Zheng K, Li H, Qi Y, Cao

QL, Qiu M (2010) Co-localization of

Nkx6.2 and Nkx2.2 homeodomain

proteins in differentiated myelinating

oligodendrocytes. Glia 2010; 58:

458-468.

Zhu Y, Park J, Hu XM, Li H, Cao QL,

Feng GS and Qiu MS (2010) Control

of oligodendrocyte generation and

proliferation by Shp2 protein tyrosine

phosphatase. Glia 2010; 58: 1407-

1414.

67

mhmni.com

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ellMore, tiMothY

Ellmore, T.M., Hood A.J., Castriotta

R., Stimming E.F., Bick R.J., Schiess

M.C. Reduced volume of the putamen

in REM Sleep Behavior Disorder

patients. (2010) Parkinsonism and

Related Disorders, 16(10): 645-649.

Schiess, M.C., Barnes, J.L., Ellmore,

T.M., Poindexter, B.J., Dinh, K., Bick,

R.J. CSF from Parkinson disease

patients differentially affects cultured

microglia and astrocytes. BMC

Neuroscience 2010; 11:151.

Ellmore, T.M., Beauchamp, M.S.,

Breier, J.I, Slater, J.D., Kalamangalam,

G.P., O’Neill, T., Disano M.A., Tandon,

N. Temporal lobe white matter

asymmetry and language laterality in

epilepsy patients. Neuroimage 2010;

49(3) 2033-2044.

GoNZales, Nicole

Mullen Conley K, Juhl Majersik J,

Gonzales NR, Maddox KE, Pary

JK, Brown DL, Moyé LA, Espinosa

N, Grotta JC, Morgenstern LB.

Kids Identifying and Defeating

Stroke (KIDS): development and

implementation of a multiethnic

health education intervention to

increase stroke awareness among

middle school students and their

parents. Health Promotion Practice

Jan 2010; 11(1):95-103. [E-pub 10

Mar 2008]

Grotta, JaMes

Sharma S, Yang B, Xi X, Grotta JC,

Aronowski J, Savitz SI. IL-10 directly

protects cortical neurons by activating

PI-3 kinase and STAT-3 pathways.

Brain Research 10 Feb 2011; 1373:

189-94. [E-pub 4 Dec 2010]

Mishra NK, Ahmed N, Andersen

G, Egido JA, Lindsberg PJ, Ringleb

PA, Wahlgren NG, Lees KR; VISTA

collaborators; SITS collaborators.

Thrombolysis in very elderly people:

controlled comparison of SITS

International Stroke Thrombolysis

Registry and Virtual International

Stroke Trials Archive. British Medical

Journal 23 Nov 2010; 341:c6046.

doi: 10.1136/bmj.c6046.

Wu TC, Grotta JC. Stroke treatment

and prevention: five new things.

Neurology. 2 Nov 2010; 75(18 Suppl

1):S16-21. Review. No abstract

available.

Ali M, Ashburn A, Bowen A, Brodie

E, Corr S, Drummond A, Edmans J,

Gladman J, Kalra L, Langhorne P,

Lees KR, Lincoln N, Logan P, Mead

G, Patchick E, Pollock A, Pomeroy

V, Sackley C, Sunnerhagen KS, van

Vliet P, Walker M, Brady M; VISTA-

Rehab Investigators. VISTA-Rehab:

a resource for stroke rehabilitation

trials. International Journal of

Stroke Dec 2010; 5(6):447-52. doi:

10.1111/j.1747-4949.2010.00485.x.

Mishra NK, Diener HC, Lyden

PD, Bluhmki E, Lees KR; VISTA

Collaborators. Influence of age on

outcome from thrombolysis in acute

stroke: a controlled comparison in

patients from the Virtual International

Stroke Trials Archive (VISTA). Stroke

Dec 2010; 41(12):2840-8. [E-pub

28 Oct 2010]. Erratum in: Stroke. Jan

2011; 42(1):e13.

Schäbitz WR, Laage R, Vogt G, Koch

W, Kollmar R, Schwab S, Schneider D,

Hamann GF, Rosenkranz M, Veltkamp

R, Fiebach JB, Hacke W, Grotta

JC, Fisher M, Schneider A. AXIS:

a trial of intravenous granulocyte

colony-stimulating factor in acute

ischemic stroke. Stroke Nov 2010;

41(11):2545-51. [E-pub 14 Oct 2010]

Mishra NK, Lyden P, Grotta JC, Lees

KR; VISTA Collaborators. Thrombolysis

is associated with consistent

functional improvement across

baseline stroke severity: a comparison

of outcomes in patients from the

Virtual International Stroke Trials

Archive (VISTA). Stroke Nov 2010;

41(11):2612-7. [E-pub 14 Oct 2010]

Arnold M, Fischer U, Compter A, Gralla

J, Findling O, Mattle HP, Kappelle LJ,

Tanne D, Algra A, Schonewille WJ;

BASICS Study Group. Acute basilar

artery occlusion in the Basilar Artery

International Cooperation Study: does

gender matter? Stroke Nov 2010;

41(11):2693-6. [E-pub 14 Oct 2010]

S E L E C t E D P u B L I C A t I O N S

69

Greenberg SM, Grotta JC, Xi

G. Intracerebral hemorrhage:

introduction. Stroke Oct 2010; 41(10

Suppl):S91. No abstract available.

Bektas H, Wu TC, Kasam M, Harun

N, Sitton CW, Grotta JC, Savitz

SI. Increased blood-brain barrier

permeability on perfusion CT might

predict malignant middle cerebral

artery infarction. Stroke Nov 2010;

41(11):2539-44. [E-pub 16 Sep 2010]

Mishra NK, Davis SM, Kaste M, Lees

KR; VISTA Collaboration. Comparison

of outcomes following thrombolytic

therapy among patients with prior

stroke and diabetes in the Virtual

International Stroke Trials Archive

(VISTA). Diabetes Care Dec 2010;

33(12):2531-7. [E-pub 15 Sep 2010]

Martin-Schild S, Albright KC, Tanksley

J, Pandav V, Jones EB, Grotta JC,

Savitz SI. Zero on the NIHSS does not

equal the absence of stroke. Annals

of Emergency Medicine Jan 2011;

57(1):42-5. [E-pub 15 Sep 2010]

Hemmen TM, Raman R, Guluma KZ,

Meyer BC, Gomes JA, Cruz-Flores S,

Wijman CA, Rapp KS, Grotta JC, Lyden

PD; ICTuS-L Investigators. Intravenous

thrombolysis plus hypothermia for

acute treatment of ischemic stroke

(ICTuS-L): final results. Stroke Oct

2010; 41(10):2265-70. [E-pub 19

Aug 2010]

Sharma S, Yang B, Strong R, Xi X,

Brenneman M, Grotta JC, Aronowski J,

Savitz SI. Bone marrow mononuclear

cells protect neurons and modulate

microglia in cell culture models

of ischemic stroke. Journal of

Neuroscience Research Oct 2010;

88(13):2869-76.

Barker CM, Gomez J, Grotta JC,

Smalling RW. Feasibility of carotid

artery stenting in patients with

angiographic string sign. Catheter

Cardiovascular Intervention. 1 Jun

2010; 75(7):1104-9.

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Lees KR, Bluhmki E, von Kummer R,

Brott TG, Toni D, Grotta JC, Albers

GW, Kaste M, Marler JR, Hamilton

SA, Tilley BC, Davis SM, Donnan GA,

Hacke W; ECASS, ATLANTIS, NINDS

and EPITHET rt-PA Study Group,

Allen K, Mau J, Meier D, del Zoppo

G, De Silva DA, Butcher KS, Parsons

MW, Barber PA, Levi C, Bladin C,

Byrnes G. Time to treatment with

intravenous alteplase and outcome

in stroke: an updated pooled analysis

of ECASS, ATLANTIS, NINDS, and

EPITHET trials. Lancet 15 May 2010;

375(9727):1695-703.

Weimar C, Ali M, Lees KR, Bluhmki E,

Donnan GA, Diener HC; VISTA Steering

Committee. The Virtual International

Stroke Trials Archive (VISTA): results

and impact on future stroke trials

and management of stroke patients.

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Patient Stories

mhmni.com

80

Twenty-five-year-old Christine Smid was in good health

until 2007, when she began to notice a sharp pain in her

face that began just below the eyelid and extended down

to her upper teeth and lip. “It came out of nowhere, a

burning, shocking pain that ran from my left cheek to my

two front teeth,” Smid says. “It started one morning while

I was making my bed. After that, I had pain several times

a week, varying from a second to five minutes.”

Because the pain involved her front teeth, she sought

help from a dentist in Austin, where she was working on

an undergraduate degree in biomedical engineering at

The University of Texas. Following root canals on her two

front teeth, the pain subsided – but only temporarily.

The dentist performed two more root canals on the

same teeth, thinking he’d left an exposed root.

While visiting family in Lake Jackson, Texas, she saw

her hometown dentist, who recognized the symptoms of

trigeminal neuralgia (TN) and referred her to a neurologist

in Houston. Often referred to as the “suicide disease,”

TN has been described as one of the most painful

conditions known.

“I tried two different medications normally prescribed for

seizures – Carbatrol® and Tegretol®. They helped but they

also affected me cognitively,” Smid says. “By then I was

a graduate student and couldn’t afford to have anything

interfering with my cognitive abilities, so I stopped the

medication and just dealt with the pain. I kept hoping it

would leave as spontaneously as it came.”

Smid lived with the pain for four years before she was

referred to Dong Kim, M.D., director of the Mischer

Neuroscience Institute and professor and chair of the

Vivian L. Smith Department of Neurosurgery at The

University of Texas Health Science Center at Houston

(UTHealth) Medical School. Dr. Kim discussed her

treatment options, including stereotactic radiosurgery

with the Leksell Gamma Knife® Perfexion™ and

microvascular decompression. After reviewing the results

of a CT angiogram, physician and patient opted for

microvascular decompression of the trigeminal nerve.

Smid went to surgery on January 19, 2011. “As with

most cases of trigeminal neuralgia, the pain was caused

by a normal artery contacting the nerve,” Dr. Kim says.

“Arteries pulsate with blood flow, and the rhythm of the

pulsations triggers the trigeminal nerve to fire, which the

brain interprets as face pain. As we grow older, arteries

that are normal and initially straight can become longer

and curve so that they touch the nerve.”

The decompression was successful, and after struggling

with the pain of TN for four years, she is now pain free.

“I would recommend the surgery to anyone suffering

from trigeminal neuralgia,” says Smid, who is now in

the third year of her doctoral program in biomedical

engineering. “Working with Dr. Kim was wonderful. I had

no complications and recovered well. Everything was

done through a quarter-size hole behind my left ear.

They shaved my head in that area but the rest of my hair

covered it up. People couldn’t believe I had brain surgery.

It was so easy.”

Christine Smid: Relief from the Suicide Disease

PAtIENt StOrIES Trigeminal Neuralgia

81

mhmni.com

I had no complications

and recovered well. People

couldn’t believe I had brain

surgery. It was so easy.

82

When 63-year-old West Texas rancher Gary McGehee

began experiencing episodes of tingling in his left

shoulder and arm in 2010, he was treated for heart

disease in San Angelo, the town located nearest the

ranch he and his wife Carolyn own in Irion County.

His cardiologist diagnosed stress-related angina and

prescribed medication that McGehee took for nearly a

year. But his condition continued to worsen, and the

episodes became more frequent and more severe.

“Gary began having symptoms about a year before

he came to see me,” says Nitin Tandon, M.D., a

neurosurgeon at the Mischer Neuroscience Institute

(MNI) and an associate professor in the Vivian L. Smith

Department of Neurosurgery at The University of Texas

Health Science Center at Houston (UTHealth) Medical

School. “In addition to the left arm and shoulder

numbness, he was blanking out frequently, which

suggested he was having complex partial seizures.”

In December 2010, McGehee suffered a tonic-clonic

seizure that triggered a visit to an emergency center in

San Angelo, where an MRI study revealed an extensive

brain mass involving the right temporal lobe, the

hippocampus and the right insular cortex – and extending

partly into the inferior portion of the frontal lobe. His

son Michael McGehee, M.D., a third-year resident at

the Baylor/UTHealth Alliance for Physical Medicine and

Rehabilitation in Houston, arranged for him to be seen

by Dr. Tandon at MNI.

“By the time I saw Gary, he was having five or six

uncontrolled seizures daily despite the multiple

anticonvulsant medications he was taking,” Dr. Tandon

says. An MRI confirmed the location and extent of the

tumor, and using Wada testing, Dr. Tandon and his team

confirmed their suspicion that the side of the brain

opposite the tumor was his dominant hemisphere for

language and memory. They took McGehee to the OR

on January 17, 2011.

The tumor Dr. Tandon removed measured 8 x 7

centimeters, about the size of a peach. “Despite its large

size and intrusion into several important structures in the

brain, we were able to resect the entire visible tumor,”

the neurosurgeon says. The pathology report confirmed a

grade 2 astrocytoma, and McGehee’s case was discussed

at MNI’s weekly multidisciplinary Brain Tumor Board.

“Balancing the benefits and risks of treatment versus

observation based on Mr. McGehee’s physical health,

tumor size and location before surgery, age and seizure

frequency, we recommended the standard-of-care

treatment for tumors of this type to kill any cancer cells

undetectable by standard imaging techniques,” says

fellowship-trained neurologist and neuro-oncologist

Jay-Jiguang Zhu, M.D., Ph.D., who is an associate

professor in the department of Neurosurgery and the

department of Neurology at the UTHealth Medical

School. “He underwent six weeks of radiation and daily

oral chemotherapy with temozolomide, followed by

temozolomide only at five days out of 28 days.”

Gary McGehee: Home on the Range

PAtIENt StOrIES Glioma

83

McGehee tolerated the treatment well, with only mild

fatigue, and is now followed by blood work every four

weeks and MRI studies every two to three months.

Since undergoing treatment, he has had no seizures

and no tingling in his arm. His MRI on June 16, 2011,

showed no evidence of tumor recurrence. “His prognosis

is excellent,” Dr. Tandon says.

McGehee’s case stands out to Dr. Tandon for three

reasons. “First, he suffered for nearly a year without a

correct assessment of the etiology of his symptoms.

Second, it was an uncommon tumor – an extensive

paralimbic-insular glioma that had grown to this size

without major disruption of essential functions. In a

surgery of this type, it’s of great importance to preserve

the subcortical pathways as well as the vessels supplying

the blood to the tumor. The surgery can be complex and

long – Gary’s took nine hours – so many surgeons prefer

to do subtotal resections or biopsies of gliomas like

these, because they’re unwilling to take the risk

of pushing the surgery to the point of accomplishing

a complete resection. As has been shown multiple

times, the extent of resection correlates strongly with

the long-term outcome. And lastly, for me it was a great

privilege to take care of a family member of one of

our colleagues.”

The McGehees, who were back working the ranch as

soon as his treatment was completed, say they felt like

they were in the right place at the right time. “From my

perspective, it was a miracle that we got Gary through

this and that miracle came through Dr. Tandon,” Carolyn

McGehee says. “He rearranged his schedule to get Gary

into surgery as quickly as possible. We were fortunate

that our son in Houston got us to the right people, and

that everything went smoothly. We’re still amazed.”

mhmni.com

the McGehees, who were

back working the ranch as

soon as his treatment was

completed, say they felt like

they were in the right place

at the right time.

84

As a three-year survivor of glioblastoma multiforme

(GBM), Janie Totten has defied the odds. “I was

determined that I wasn’t going to let this cancer beat

me,” says the 60-year-old Houston resident. After my

surgery, I did exercises at home with my arms and fingers

and got stronger and stronger. I decided I was going to

walk and do everything I did before I was diagnosed

with brain cancer, but at a slower pace. I always kept

a positive attitude, and I had a lot of support from my

husband, my son Christopher and my daughter Caroline –

and lots of prayers. I knew everyone cared.”

Totten’s positive attitude and strong will to live are

just two of the many factors contributing to her long-

term survival, says fellowship-trained neurologist and

neuro-oncologist Jay-Jiguang Zhu, M.D., Ph.D., who

has managed Totten’s care since he joined the Mischer

Neuroscience Institute (MNI) in September 2010. “The

median survival for patients with GBM is 14.6 months

after diagnosis,” Dr. Zhu says. “Mrs. Totten has done

well because she has many things going for her – her

age, the type of tumor resection and the skill with

which it was performed, as well as her physical and

emotional strength. She had no significant disability

following removal of the tumor. She tolerated radiation

and chemotherapy well, and she had a good support

system at home. Because she was treated at MNI,

she had the benefit of the multidisciplinary resources

of our weekly Neuro-Oncology Tumor Board at which

neurosurgeons, radiation oncologists, neuroradiologists

and neuropathologists discuss cases to ensure the

best treatment.”

Totten presented at the Emergency department of

Memorial Hermann Northeast Hospital in September

2008, with numbness in her legs following a seizure. When

a CT scan revealed a brain mass, she was referred to Dong

Kim, M.D., director of the Mischer Neuroscience Institute

and professor and chair of the Vivian L. Smith Department

of Neurosurgery at The University of Texas Health Science

Center at Houston (UTHealth) Medical School. Dr. Kim

performed a total resection of the GBM, following motor

function mapping done by MNI neurosurgeon Nitin Tandon,

M.D., to maximize tumor removal while minimizing the

possibility of motor deficit after surgery.

In late October 2008, Totten started a six-week course

of radiation therapy and chemotherapy with oral

temozolomide. By January 2009, she was receiving a

maintenance dose of temozolomide five days out of

every 28. She continued chemotherapy until mid-October

2010, during which time she was followed regularly with

blood work and MRI studies.

“The standard for administration of temozolomide in GBM

patients is six months,” says Dr. Zhu, who is an associate

professor in the department of Neurosurgery and the

department of Neurology at the UTHealth Medical School.

“Mrs. Totten was able to tolerate her chemotherapy

regimen for a year and a half without significant side

effects, which contributed to her outcome. She was doing

well, with the exception of episodic seizures about once

every two months. Balancing the benefit and potential

side effects of long-term use of temozolomide, we

discussed stopping chemotherapy.”

Janie totten: Against All Odds

PAtIENt StOrIES Glioblastoma Multiforme

85

After discontinuing the temozolomide, Dr. Zhu followed

Totten every two months with MRI and physical

examination; her MRI results were reviewed at the

weekly meetings of the MNI Brain Tumor Board.

When a lesion was discovered on an MRI study done

in May 2011, she underwent stereotactic radiosurgery

at Memorial Hermann-Texas Medical Center. The

procedure was performed by Dr. Kim and radiation

oncologist Clive Shkedy, M.D., using MNI’s Leksell

Gamma Knife® Perfexion™. As the most technologically

advanced Gamma Knife model available, the

Perfexion allows for the treatment of a broader range

of anatomical structures than earlier Gamma Knife

models. It also improves treatment planning and

patient comfort, and reduces treatment time.

“By using the Gamma Knife, we can destroy most

of the tumor,” says Dr. Zhu. “Moving forward, we’ll

follow her closely and plan to use the angiogenesis

inhibitor bevacizumab if there’s any evidence of

tumor growth.”

Totten and her husband, George, have kept a

journal since she began treatment in 2008. “Writing

things down has helped us keep track of doctors’

appointments, treatments and progress,” she says.

“When you have the kind of surgery I had and undergo

chemotherapy for as long as I did, it’s hard to remember

things, so the journal has been very useful. But the

most important thing is to keep a positive attitude.

Always stay strong, and never give up.”

mhmni.com

I was determined that

I wasn’t going to let this

cancer beat me.

Christine Portillo’s story has the power to save lives.

It begins in 1998, the year her mother suffered a stroke

as the result of two ruptured intracranial aneurysms.

“She recovered quickly and went back to work two weeks

later, but we don’t remember anyone telling the family

that aneurysms can be hereditary,” Portillo says. “And no

one told her that she should be checked annually for

a recurrence.”

Twelve years later, near the end of 2010, Portillo’s mother

was diagnosed with normal pressure hydrocephalus

(NPH), an abnormal increase of cerebrospinal fluid

(CSF) in the brain’s ventricles that occurs when the

normal flow of CSF is in some way blocked. As the

ventricles enlarge, pressure on the brain increases.

She was admitted to Memorial Hermann-Texas Medical

Center under the care of Dong H. Kim, M.D., director of

the Mischer Neuroscience Institute and professor and

chair of the Vivian L. Smith Department of Neurosurgery


Houston (UTHealth) Medical School. He placed a

ventricular shunt in the fluid-filled chamber to relieve

pressure on the brain.

“Our entire family was by her side to help her through

the surgery,” Portillo says. “We came in for a follow-up

with Dr. Kim about her progress and near the end of

the consultation, he said, ‘I’d really like you to see

our geneticist.’ So we sat around the table with

the geneticist – my mom and dad, my sister and I.

My two brothers weren’t with us at the time. They told

us we should be checked for aneurysm, and they gave us

a letter to give to our family members recommending

that they be screened as well.”

Portillo, who is 51, was the first of her family members

to undergo screening. The results of a magnetic

resonance arteriogram (MRA) and subsequent cerebral

arteriogram revealed the presence of five aneurysms,

four of which were around the brain and could have

caused serious hemorrhage. “Based on her family

history and the fact that she presented with multiple

aneurysms, she was at higher risk of rupture than

patients in the general population, so I recommended

surgery,” Dr. Kim says.

Portillo underwent two procedures. On March 21, 2011,

Dr. Kim performed a left frontal craniotomy and clipped

the aneurysms in the left ophthalmic segment and left

posterior communicating artery. At a two-week follow-

up visit he noted that she was healing well, with no

neurological deficits as a result of the surgery.

“My recovery was actually surprisingly rapid,” she recalls.

“Three weeks to the day after the surgery, I was back

on my regular workout schedule at the Y.” Between the

two surgeries, she helped nurse her husband through

a prostatectomy, helped plan her eldest daughter’s

wedding, continued her job search online and accepted

a position at a Houston-based design and marketing

communications firm.

86

Christine Portillo: A Matter of Genetics

PAtIENt StOrIES Intracranial Aneurysm

87

Before my surgery, Dr. Kim

took my hands in his and

said, ‘Don’t be afraid.

I want you to live a long

and happy life.’

mhmni.com

Portillo’s second surgery took place on May 2, 2011.

Dr. Kim performed a right frontal craniotomy and

successfully clipped two additional intracranial

aneurysms – in the right posterior communicating

artery and the right anterior choroidal artery.

“During these months of interacting with Dr. Kim and MNI

staff, I learned about my risk factors, particularly genetics

and smoking,” she says. “I was a light smoker in the

past – off and on – and I’m so proud of myself for quitting

for good. I’m borderline high blood pressure. Other than

that, I think my case was mostly a matter of genetics.

I want people to know that if someone in their family was

diagnosed with either a ruptured or unruptured aneurysm

– whether they’re a child, a sibling or a grandchild – they

should be screened. I consider myself so fortunate that

mine were discovered, and so grateful to have been

operated on by someone of Dr. Kim’s caliber.”

In follow-up, Portillo will be screened every year. She

has also encouraged her two daughters to be screened

according to the current guidelines – every five years,

starting at age 30. Twenty-one-year-old Veronica Portillo

is a recent graduate of The University of Texas at Austin,

and 24-year-old Elyse Portillo is pursuing a medical

degree at Baylor College of Medicine. Portillo’s older

sister, who was screened in early 2011, is free

of aneurysm.

After consenting to participate, Portillo and her family

became part of the more than 500 families affected

by intracranial aneurysms that have been described

to date in research conducted by Dr. Kim and Teresa

Santiago-Sim, Ph.D., an assistant professor in the Vivian

L. Smith Department of Neurosurgery. The study was

funded by the National Institutes of Health and by

the American Heart Association/Burgher Foundation.

“Our long-term goals are to identify causative mutations

in intracranial aneurysms and altered molecular

pathways that lead to disease,” Dr. Kim says.

Working with DNA samples stored in the department’s

Neuroscience Research Repository, Dr. Santiago-Sim

has used linkage analysis of a large family with a history

of hereditary intracranial aneurysms to identify a novel

region in the genome. “In the process of characterizing

the gene, we think we’ve identified a possible mutation,”

she says.

“Standardized electronic health data and samples

are collected in a uniform manner, which makes the

information in the database very consistent,” she adds.

“It’s also very extensive, describing the type and shape

of the aneurysm, whether it was ruptured or remained

intact at the time of diagnosis, whether the patient

has a positive or negative family history for aneurysms

and other possible related inherited diseases such as

polycystic kidney disease or stroke. This information will

help us identify genotype-phenotype correlations that will

ultimately improve the way we manage patient care.”

Portillo’s strongest impression of her experience

at MNI is the care she received. “It was phenomenal.

We can’t believe how lucky we are to live in a city with

such amazing medical resources,” she says. “We felt like

we’ve made friends. Because of the compassion of my

caregivers, being a brain surgery patient seemed less

frightening. Before my surgery, Dr. Kim took my hands in

his and said, ‘Don’t be afraid. I want you to live a long

and happy life.’ He calmed and reassured me, and I

remember being fascinated with his hands. Those are

the hands that cured me.”88

Intracranial Aneurysm PAtIENt StOrIES

89

mhmni.com

PAtIENt StOrIES Ischemic Stroke

Martha Mazzola recalls very little of the evening she

suffered an acute ischemic stroke. “It started out as a

day just like any other, and along toward evening I found

myself sitting on a chair at our kitchen table with my

husband on his knees beside me saying he was going to

call 911,” the 84-year-old Houston resident says. “I said,

‘Why? I’m fine.’ He told me that he couldn’t understand

me, that my speech was totally garbled.”

Mazzola remembers that the ambulance passed nearby

hospitals as it sped toward the Mischer Neuroscience

Institute (MNI) at Memorial Hermann-Texas Medical

Center, which houses the largest and most comprehensive

neuroscience program in Texas and is home to the

10-county Greater Houston area’s largest onsite stroke

team. By working closely with the Houston Fire Department

and local EMS services, MNI’s stroke team has logged an

impressive record of success in the administration of tissue

plasminogen activator (tPA) – more than 10 times the

national average of 2 percent.

When Mazzola arrived at the Emergency Center, neurologist

Andrew Barreto, M.D., a member of MNI’s stroke team,

administered tPA. He also determined that she was a good

candidate for an additional investigational therapy that

applies ultrasound energy to help dissolve the blood clots

that cause ischemic stroke.

When her family consented, Mazzola became one of more

than 35 people at two American study sites to benefit

from participation in a Phase I/II study to determine the

safety of a novel, external hands-free transcranial Doppler

ultrasound system in healthy volunteers and ischemic

stroke patients. James C. Grotta, M.D., co-director of MNI

and professor and chair of the department of Neurology at

The University of Texas Health Science Center at Houston

(UTHealth) Medical School, is principal investigator of

the study, the formal name of which is “CLOTBUST-Hands

Free: Combined Lysis of Thrombus in Brain Ischemia with

Transcranial Ultrasound and Systemic tPA.” The device

is under study at the UTHealth Medical School and the

University of Alabama at Birmingham; if found to be

Martha Mazzola: A Day Unlike Any Other

safe, it will enable the more widespread use of operator-

independent, ultrasound-enhanced thrombolysis and the

planning of a large Phase III efficacy trial.

The results of the original multicenter, randomized

CLOTBUST trial, coordinated by the UTHealth Medical

School and published in the New England Journal of

Medicine in 2004, found that continuous transcranial

Doppler ultrasound improved tPA-induced arterial

recanalization. “In the original study, Dr. Grotta and the

CLOTBUST investigators combined tPA with a handheld

ultrasound probe,” says Dr. Barreto, who is co-principal

investigator of CLOTBUST-Hands Free and an assistant

professor at the UTHealth Medical School. “Half of the

126 patients enrolled received tPA alone and half were

treated using tPA and the handheld device. When the

results justified a larger study, the investigators decided

it would be more efficient to develop a head frame

for hands-free application of ultrasound than to train

neurologists how to use the handheld device.” Andrei

Alexandrov, M.D., also a co-principal investigator of

the study and current director of the Comprehensive

Stroke Research Center at the University of Alabama

at Birmingham, developed the helmet-like, hands-

free device currently under study. Dr. Alexandrov was

previously a member of the MNI stroke team.

The CLOTBUST-HF study population includes 15 healthy

volunteers who assessed the safety of the device in

Phase I of the trial by tolerating two hours of transcranial

ultrasound delivered through the head frame. All Phase

I participants had normal brain MRIs before and after

ultrasound. A detailed physical examination of skin

integrity post-insonation determined that there also were

no adverse dermatological effects.

Participants in Phase IIa and IIb received intravenous (IV)

tPA according to American Heart Association/American

Stroke Association treatment guidelines. Phase IIa of the

study included 20 patients with ischemic stroke treated

with IV tPA within 4.5 hours of the event; they will be

followed for three years. Phase IIb, currently under way,

will include 40 patients with ischemic stroke treated with

IV tPA and randomized to receive either ultrasound therapy

or sham therapy. All patients will be evaluated for arterial

recanalization two hours after treatment to determine if

the clot has dissolved. Patients will be followed for three

months and have their stroke deficits measured using

the National Institutes of Health Stroke Scale, and any

remaining disability scored using modified Rankin Scale.

“Mrs. Mazzola’s clot had completely dissolved after the

tPA plus hands-free ultrasound treatment was completed,”

Dr. Barreto says. “Because we were able to open the artery

so quickly, we averted a large, life-threatening stroke.”

Martha Mazzola says she’s amazed she survived the stroke

with so little damage. “The EMS folks took me to the right

hospital, and I’m glad I had the opportunity to participate

in the study,” she says. “You can’t offer new treatments

without people who are willing to be pioneers and test

them. People have been surprised by the speed of my

recovery, and I’m pleased with my results. I saw the scans

of my brain before and after. Such a dramatic difference

between the two!”

1 Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-

Sabin, J, Montaner J, Saqqur M, Demchuk AM, Moyé LA, Hill MD,

Wojner AW for the CLOTBUST Investigators. Ultrasound-Enhanced

Systemic Thrombolysis for Acute Ischemic Stroke. New England

Journal of Medicine 2004; 351:2170-2178.

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Ischemic Stroke PAtIENt StOrIES

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mhmni.com

PAtIENt StOrIES Traumatic Brain Injury

The Mischer Neuroscience Institute (MNI) and TIRR

Memorial Hermann took the national stage when

U.S. Rep. Gabrielle Giffords was transferred to

Memorial Hermann-Texas Medical Center’s

Neuroscience Intensive Care Unit on Friday,

Jan. 21, 2011. The Arizona congresswoman was

shot in the head at pointblank range on Jan. 8

when an assailant opened fire outside a grocery store

in Tucson, killing six people and wounding 13 others.

She was transported to University Medical Center

in critical condition, and a portion of her skull was

removed to relieve brain swelling.

rep. Gabrielle Giffords: On the Road to Recovery

Gabby looked terrific when

she returned to Congress.

She has a strong will to

recover, and we look

forward to seeing the next

milestone in her journey.

In a press conference immediately following Rep. Giffords’

transition to Memorial Hermann-TMC, medical teams

from both hospitals described her transfer of care as

“seamless.”

“It was a very smooth transfer, thanks to the collaborative

efforts of both hospitals and the help of the U.S. Capitol

Police and the Navy,” says Imoigele Aisiku, M.D., medical

director of the Neuroscience ICU and Neurosurgery

Intermediate Care Unit at MNI. “She was medically stable

when she arrived and began rehabilitation the following

day. From medical data and our own experience, we know

that the earlier we begin the rehabilitation process, the

faster a patient will regain function down the road.”

Rep. Giffords’ physician team upgraded her condition

from serious to good four days after her admission to

MNI, and she was transferred to TIRR Memorial Hermann

to begin inpatient rehabilitation. At the rehabilitation

hospital, a multidisciplinary team of physicians, nurses

and therapists who specialize in head trauma worked

closely with Rep. Giffords to develop the best combination

of therapies for a return to function.

“We’re like an orchestra,” says Gerard Francisco,

M.D., chief medical officer of TIRR Memorial Hermann

and professor and chair of the department of Physical

Medicine and Rehabilitation at The University of Texas

Health Science Center at Houston (UTHealth) Medical

School, who was in charge of Rep. Giffords’ care during

her stay at the rehabilitation hospital. “The comprehensive

rehabilitation services we provide treat the whole person

and expedite recovery.”

“Because TIRR Memorial Hermann is on our Campus, she

had the same physician team in two locations from day

one,” says Dr. Aisiku, who is also vice chair of the division

of Critical Care and an associate professor in the Vivian

L. Smith Department of Neurosurgery at the UTHealth

Medical School. “I continued to see her during her stay

at TIRR Memorial Hermann, and when she was readmitted

to the acute care hospital for cranioplasty, her physical

medicine and rehabilitation team saw her here. There

were no walls between us.”

On May 18, neurosurgeon Dong Kim, M.D., performed

a successful cranioplasty to replace the piece of Rep.

Giffords’ skull that was removed on Jan. 8. He attached

a plastic computer-generated implant to her skull, along

with a shunt to drain fluid, eliminating the need for a

protective helmet.

On June 8, she celebrated another milestone – her

41st birthday. “Since Gabby arrived in Houston and at

Memorial Hermann, we have been consistently pleased

with the strides she has made,” says Dr. Kim, who

is director of the Mischer Neuroscience Institute and

professor and chair of the Vivian L. Smith Department

of Neurosurgery at the UTHealth Medical School.

“I could not be more proud of how far she has come.

She looked terrific when she returned to Congress on

Aug. 1, and her presence there offers clear signs of

cognitive improvement, physical strength and personal

confidence. She has a strong will to recover, and we look

forward to seeing the next milestone in her journey.”

92

traumatic Brain Injury PAtIENt StOrIES

93

mhmni.com

I continued to see her during

her stay at tIrr Memorial

Hermann, and when she

was readmitted to the acute

care hospital for cranioplasty,

her physical medicine and

rehabilitation team saw her

here. there were no walls

between us.

94

BraiN tuMors & Neuro-oNcoloGY

Dong Kim, M.D.DirectorMischer Neuroscience Institute

Chief of NeurosurgeryMemorial Hermann-Texas Medical Center

Professor and ChairVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Juan ortega-Barnett, M.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

scott shepard, M.D.DirectorGamma Knife Radiosurgery ProgramMischer Neuroscience Institute

Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Nitin tandon, M.D.Associate ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Jay-Jiguang Zhu, M.D., ph.D.Neuro-OncologistAssociate ProfessorVivian L. Smith Department of Neurosurgery,Department of NeurologyUTHealth Medical School

cereBrovascular Disease

andrew Barreto, M.D.Assistant Professor Department of Neurology UTHealth Medical School

p. roc chen, M.D.Assistant Professor Vivian L. Smith Department of NeurosurgeryUTHealth Medical School

arthur l. Day, M.D. Director of Clinical Education Mischer Neuroscience Institute

Professor and Vice Chair Vivian L. Smith Department of Neurosurgery UTHealth Medical School

Nicole r. Gonzales, M.D.Assistant Professor Department of Neurology UTHealth Medical School

James c. Grotta, M.D.Co-Director Mischer Neuroscience Institute

Chief of Neurology and Director Stroke Center Memorial Hermann-Texas Medical Center

Professor and Chair Department of Neurology

Roy M. and Phyllis Gough Huffington Distinguished Chair in Neurology UTHealth Medical School

Dong Kim, M.D.DirectorMischer Neuroscience Institute

Chief of NeurosurgeryMemorial Hermann-Texas Medical Center

Professor and ChairVivian L. Smith Department of NeurosurgeryUTHealth Medical School

George lopez, M.D.Associate ProfessorDepartment of NeurologyUTHealth Medical School

vivek Misra, M.D. Clinical InstructorDepartment of Neurology UTHealth Medical School

sean savitz, M.D.Associate Professor Department of Neurology

Co-Director Stroke Program

Director Vascular Neurology Fellowship UTHealth Medical School

tzu-ching (teddy) Wu, M.DTelemedicine Director Mischer Neuroscience Institute

Assistant Professor Department of Neurology UTHealth Medical School

Frank Yatsu, M.D.Professor and Chair Emeritus Department of Neurology UTHealth Medical School

critical care

imo aisiku, M.D.Director Neuroscience Intensive Care Unit Neurosurgery Intermediate Care UnitMemorial Hermann-Texas Medical Center

Associate Professor, Vivian L. Smith Department of Neurosurgery

Vice-Chair Division of Critical Care UTHealth Medical School

Bilal rana, D.o.Assistant ProfessorVivan L. Smith Department of NeurosurgeryUTHealth Medical School

hanh truong, M.D.Assistant Professor Vivian L. Smith Department of NeurosurgeryUTHealth Medical School

George W. Williams, ii, M.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

asma Zakaria, M.D.Assistant Professor Vivian L. Smith Department of Neurosurgery, Department of Neurology UTHealth Medical School

DeMeNtia

paul e. schulz, M.D.Associate Professor and Vice ChairDepartment of Neurology

Director Dementia ProgramUTHealth Medical School

DiaGNostic NeuroloGY

ernesto infante, M.D.Assistant Professor Department of NeurologyUTHealth Medical School

Staff Listing

95

mhmni.com

raymond a. Martin, M.D., F.a.a.N.Professor Department of Neurology

Medical Director Outpatient Neurology Clinic UTHealth Medical School

Melissa thomas, M.D.Assistant Professor Department of Neurology UTHealth Medical School

holly Knudsen varner, M.D.Assistant ProfessorDepartment of NeurologyUTHealth Medical School

epilepsY

James Ferrendelli, M.D.ProfessorDepartment of NeurologyUTHealth Medical School

omotola hope, M.D.Assistant ProfessorDepartment of Neurology

DirectorNeurology Residency Training ProgramUTHealth Medical School

Giridhar Kalamangalam, M.D., D.phil.Assistant ProfessorDepartment of NeurologyUTHealth Medical School

Jeremy slater, M.D.Medical DirectorEpilepsy Monitoring Unit and NeurophysiologyMemorial Hermann-Texas Medical Center

Associate ProfessorDepartment of NeurologyUTHealth Medical School

Nitin tandon, M.D.Associate ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Multiple sclerosis

staley Brod, M.D.ProfessorDepartment of NeurologyUTHealth Medical School

John a. lincoln, M.D.Assistant ProfessorDepartment of NeurologyUTHealth Medical School

John William lindsey, M.D.ProfessorDepartment of NeurologyUTHealth Medical School

Flavia Nelson, M.D.Assistant ProfessorDepartment of Neurology

Associate DirectorMagnetic Resonance Imaging Analysis CenterUTHealth Medical School

Jerry s. Wolinsky, M.D.Bartels Family and Opal C. Rankin Professor of Neurology

DirectorMultiple Sclerosis Research Group (MSRG)

DirectorMagnetic Resonance Imaging Analysis CenterUTHealth Medical School

MoveMeNt DisorDers & NeuroDeGeNerative Diseases

albert Fenoy, M.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

anita Madan, M.D.Assistant ProfessorDepartment of NeurologyUTHealth Medical School

William ondo, M.D.ProfessorDepartment of NeurologyUTHealth Medical School

Mya schiess, M.D.Professor and Vice ChairDepartment of NeurologyAdriana Blood Endowed Chair in Neurology

Director Movement Disorders and Neurodegenerative Disease

Director UT MOVE Clinic UTHealth Medical School

erin Furr-stimming, M.D.Assistant ProfessorDepartment of Neurology

Movement Disorders SpecialistUT MOVE Clinic

DirectorNeurology Clerkship ProgramUTHealth Medical School

Gage van horn, M.D.ProfessorDepartment of NeurologyUTHealth Medical School

NeuroMuscular DisorDers

parveen athar, M.D.Assistant ProfessorDepartment of Neurology UTHealth Medical School

suur Biliciler, M.D.Assistant ProfessorDepartment of NeurologyUTHealth Medical School

Kazim shiekh, M.D.ProfessorDepartment of Neurology

DirectorNeuromuscular ProgramUTHealth Medical School

NeurorehaBilitatioN

Nneka ifejika, M.D.Assistant ProfessorDepartment of Neurology

Director of NeurorehabilitationUTHealth Medical School

elizabeth Noser, M.D.Medical DirectorNeurorehabiliation Memorial Hermann-Texas Medical Center

Clinical Assistant ProfessorDepartment of NeurologyUTHealth Medical School

96

NeurotrauMa

Bryan oh, M.D.DirectorNeurotrauma UnitMemorial Hermann-Texas Medical Center

Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Karl schmitt, M.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

scott shepard, M.D.Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

spiNe

paul Boone, M.D.Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

raul J. cardenas, M.D.Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

arthur l. Day, M.D.Director of Clinical EducationMischer Neuroscience Institute

Professor and Vice ChairVivian L. Smith Department of NeurosurgeryUTHealth Medical School

albert Fenoy, M.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Michele M. Johnson, M.D.Assistant ProfessorVivian L. Smith Department of Neurosurgery

DirectorSpine ProgramUTHealth Medical School

Juan ortega-Barnett, M.D.Assistant Professor Vivian L. Smith Department of Neurosurgery UTHealth Medical School

Karl schmitt, M.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

scott shepard, M.D.DirectorGamma Knife Radiosurgery ProgramMischer Neuroscience Institute

Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Quoc anh thai, M.D.Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

Geoffrey p. Zubay, M.D., F.a.c.s.Clinical Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical School

research FacultY

Jaroslaw (Jarek) aronowski, ph.D.ProfessorDepartment of NeurologyUTHealth Medical School ISCHEMIC STROKE AND BRAIN HEMORRHAGE

Qilin cao, M.D.Associate ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolSTEM CELL THERAPY

Guy clifton, M.D.DirectorVivian L. Smith Center for Neurologic Research

ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolBRAIN INJURY

pramod Dash, M.D.ProfessorVivian L. Smith Department of Neurosurgery, and Department of Neurobiology and AnatomyUTHealth Medical SchoolBRAIN INJURY

timothy ellmore, ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolNEURAL SUBSTRATES OF LANGUAGE AND MEMORY

Georgene hergenroeder, r.N.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolBIOINFORMATICS AND TRANSLATIONAL RESEARCH

Nobuhide Kobori, M.D., ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolBRAIN INJURY AND MEMORY

Min li, ph.D.Associate ProfessorVivian L. Smith Department of Neurosurgery

DirectorCancer Research ProgramUTHealth Medical SchoolNEURO-ONCOLOGY

Ying liu, M.D., ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolSTEM CELL RESEARCH

hariyadarshi pannu, ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolVASCULAR DISEASE AND GENETICS

teresa santiago-sim, ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolVASCULAR DISEASE AND GENETICS

claudio soto, ph.D.DirectorCenter for Neurodegenerative Diseases

Professor of NeurologyUTHealth Medical SchoolNEURODEGENERATIVE DISEASE

Jia Qian Wu, ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolSTEM CELL RESEARCH

Ying Xia, M.D., ph.D.Professor and Vice ChairVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolCELLULAR AND MOLECULAR NEUROSCIENCE

rong Yu, ph.D.Assistant ProfessorVivian L. Smith Department of NeurosurgeryUTHealth Medical SchoolOXIDATIVE STRESS AND BRAIN INJURY

Gang Zhang, M.D.Assistant ProfessorDepartment of NeurologyUTHealth Medical SchoolPERIPHERAL NERVOUS SYSTEM

Xiurong Zhao, M.D.Associate ProfessorDepartment of NeurologyUTHealth Medical SchoolISCHEMIC STROKE AND BRAIN HEMORRHAGE

S t A F F L I S t I N G

Mischer Neuroscience Institute Memorial Hermann-Texas Medical Center

6411 FanninHouston, TX 77030

mhmni.com memorialhermann.org713.222.CARE (2273)

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